NPI 1003625112

Populus Primus LLC

Organisation Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Wimauma, FL

Practice location

Address: 14523 Callen Glen Way, Wimauma, FL 33598-6179
Phone: (727) 226-2196

Authorised official

Name: Tanisha Foster
Title: Owner
Phone: (727) 226-2196

Registered specialties

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary

Residential Treatment Facilities Taxonomy 320900000X

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Registry record

NPI: 1003625112
Entity type: Organization
NPI issued: 3 Jan 2025
Record last updated: 3 Jan 2025

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.