NPI 1154664043

Wisteria Elderly Care, LLC

Organisation Respite Care Palm Bay, FL

Practice location

Address: 189 Donald Ave NE, Palm Bay, FL 32907-3158
Phone: (321) 345-4177
Fax: (321) 345-4177

Authorised official

Name: Witza Larionne
Title: Owner
Phone: (321) 345-4177

Registered specialties (2)

Respite Care Primary

Respite Care Facility Taxonomy 385H00000X Licence 6906533 (FL)

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Private Vehicle

Transportation Services Taxonomy 347C00000X Licence 232475 (FL)

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Registry record

NPI: 1154664043
Entity type: Organization
NPI issued: 29 Mar 2013
Record last updated: 29 Mar 2013

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.