| Doctor Name: | MRS. VERA RENITA MATHIS |
| NPI Number: | 1568897700 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 6906328 |
| Business Practice Address: | 331 Thomasdale Ave Haines City, FL - 338446381 |
| Business Phone Number: | 8632421261 |
| Business Fax Number: | |
| Mailing Address: | 331 Thomasdale Ave, HAINES CITY |
| State: | FL |
| Postal Code: | 338446381 |
| Phone Number: | 8632421261 |
| Fax Number: | |
| NPI Enumeration Date: | 09/06/2013 |
| NPI Last Update Date: | 09/06/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 311ZA0620X |
| License Number: | 6906328 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Nursing & Custodial Care Facilities |
| Taxonomy Classification: | Custodial Care Facility |
| Taxonomy Specialization: | Adult Care Home |
| Taxonomy Definition: | A custodial care facility providing supportive and personal care services to disabled and/or elderly individuals who cannot function independently in most areas of activity and need assistance and monitoring to enable them to remain in a home like environment. |