Provider Demographics
NPI:1144687161
Name:PATRICIA'S ROCK
Entity type:Organization
Organization Name:PATRICIA'S ROCK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DELISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BONAPARTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-566-1975
Mailing Address - Street 1:425 W COLONIAL DR
Mailing Address - Street 2:201
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:904-566-1975
Mailing Address - Fax:
Practice Address - Street 1:425 W COLONIAL DR
Practice Address - Street 2:201
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6863
Practice Address - Country:US
Practice Address - Phone:904-566-1975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PATRICIA'S ROCK
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009272800Medicaid