Provider Demographics
NPI:1265285845
Name:HEART OF GOD CRAE CENTER
Entity type:Organization
Organization Name:HEART OF GOD CRAE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KARIEEM
Authorized Official - Middle Name:ALI
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-482-5863
Mailing Address - Street 1:10004 CREEK BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-7559
Mailing Address - Country:US
Mailing Address - Phone:813-482-5863
Mailing Address - Fax:
Practice Address - Street 1:311 E ROBERTSON ST
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5253
Practice Address - Country:US
Practice Address - Phone:813-482-5863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services