Provider Demographics
NPI:1710353024
Name:ANRIC ENTERPRISES, INC
Entity Type:Organization
Organization Name:ANRIC ENTERPRISES, INC
Other - Org Name:ST CLOUD HAVEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-476-5253
Mailing Address - Street 1:115 MARGARET ST STE C
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5257
Mailing Address - Country:US
Mailing Address - Phone:813-689-8777
Mailing Address - Fax:813-689-8776
Practice Address - Street 1:2813 SAINT CLOUD OAKS DR
Practice Address - Street 2:
Practice Address - City:VALRICO
Practice Address - State:FL
Practice Address - Zip Code:33594-3840
Practice Address - Country:US
Practice Address - Phone:813-661-8918
Practice Address - Fax:813-689-8776
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANRIC ENTERPRISES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-20
Last Update Date:2017-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL12044310400000X
FL302117722253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL693767502Medicaid