Individual provider · Type 1 NPI

Zandra Wynette Wallace

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Tampa, FL

NPI number 1053063412 Active

Practice location

20316 Natures Corner Dr
Tampa, FL 33647-3580

Call (813) 575-8108 Map

Specialties and licenses

TaxonomyCodeLicense
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary 320900000XNone listed

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.

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About NPI 1053063412

Zandra Wynette Wallace's National Provider Identifier is 1053063412, issued on Jan 26, 2022. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Tampa, FL. The record was last updated on Jan 26, 2022.