Provider Demographics
NPI:1922204247
Name:UNITED STATES FELLOWSHIP OF FLORIDA, INC.
Entity Type:Organization
Organization Name:UNITED STATES FELLOWSHIP OF FLORIDA, INC.
Other - Org Name:THE HERON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-743-4129
Mailing Address - Street 1:1320 COCO PLUM DR
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-4015
Mailing Address - Country:US
Mailing Address - Phone:305-743-4129
Mailing Address - Fax:305-743-5137
Practice Address - Street 1:1320 COCO PLUM DR
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-4015
Practice Address - Country:US
Practice Address - Phone:305-743-4129
Practice Address - Fax:305-743-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL85233104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness