Individual provider · Type 1 NPI
Tequela Yashan Donaldson
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Sanderson, FL
Practice location
14044 Friendship Pl
Sanderson, FL 32087-2489
Fax (904) 409-0012
Mailing address
PO Box 163
Sanderson, FL 32087-0163
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary | 320900000X | None 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.
About NPI 1780154062
Tequela Yashan Donaldson's National Provider Identifier is 1780154062, issued on Nov 29, 2018. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Sanderson, FL. The record was last updated on Nov 29, 2018.