Provider Demographics
NPI:1982461828
Name:BRUISED BUT NOT DESTROYED INC
Entity Type:Organization
Organization Name:BRUISED BUT NOT DESTROYED INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:TANIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-928-8177
Mailing Address - Street 1:653 ORISTA DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-9589
Mailing Address - Country:US
Mailing Address - Phone:813-928-8177
Mailing Address - Fax:
Practice Address - Street 1:653 ORISTA DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-9589
Practice Address - Country:US
Practice Address - Phone:813-928-8177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities