Provider Demographics
NPI:1265836985
Name:SHIRLEY WRIGHT DBA CLOBRAN ASSISTED LIVING FACILITY
Entity type:Organization
Organization Name:SHIRLEY WRIGHT DBA CLOBRAN ASSISTED LIVING FACILITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMININTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:MAY
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-680-1959
Mailing Address - Street 1:4405 SW 102ND LANE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34476-4143
Mailing Address - Country:US
Mailing Address - Phone:352-873-8492
Mailing Address - Fax:352-873-8492
Practice Address - Street 1:3 CLEAR PL
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34472-2310
Practice Address - Country:US
Practice Address - Phone:352-680-1959
Practice Address - Fax:352-687-1806
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHIRLEY WRIGHT DBA CLOBRAN ASSISTED LIVING FACILITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL108253104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1295038701Medicaid