Populus Primus LLC

NPI #1003625112 in Wimauma, Florida

Provider Information

NPI Number: 1003625112
Entity Type: Organization
Organization Name: Populus Primus LLC
Primary Specialty: Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Enumeration Date: Jan 3, 2025
Last Updated: Jan 3, 2025

Practice Location

Address: 14523 CALLEN GLEN WAY
City: Wimauma
State: Florida
ZIP Code: 33598-6179
Phone: (727) 226-2196

Authorized Official

Name: TANISHA FOSTER
Title: OWNER
Phone: (727) 226-2196

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities	320900000X	Primary

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