Provider Demographics
NPI:1497368203
Name:CAREOLA LLC
Entity Type:Organization
Organization Name:CAREOLA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:TYRONE
Authorized Official - Last Name:PETERKIN
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:352-250-2237
Mailing Address - Street 1:3248 LANDING VW
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-2035
Mailing Address - Country:US
Mailing Address - Phone:352-250-2237
Mailing Address - Fax:352-327-7030
Practice Address - Street 1:3248 LANDING VW
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-2035
Practice Address - Country:US
Practice Address - Phone:352-250-2237
Practice Address - Fax:352-327-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities