Provider Demographics
NPI:1730346404
Name:GARDEN INN
Entity type:Organization
Organization Name:GARDEN INN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LANIER
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:352-840-9562
Mailing Address - Street 1:5801 NW 31ST AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-2917
Mailing Address - Country:US
Mailing Address - Phone:352-840-9562
Mailing Address - Fax:
Practice Address - Street 1:5801 NW 31ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-2917
Practice Address - Country:US
Practice Address - Phone:352-840-9562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13001339A251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services