Provider Demographics
NPI:1801381199
Name:COMFORT VILLA CARES
Entity Type:Organization
Organization Name:COMFORT VILLA CARES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RADICA
Authorized Official - Middle Name:ANNIE
Authorized Official - Last Name:SOOKLALL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-445-6670
Mailing Address - Street 1:6953 CRESCENT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-5020
Mailing Address - Country:US
Mailing Address - Phone:407-445-6670
Mailing Address - Fax:407-445-6646
Practice Address - Street 1:6953 CRESCENT RIDGE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-5020
Practice Address - Country:US
Practice Address - Phone:407-445-6670
Practice Address - Fax:407-445-6646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities