1144523697 NPI number — ROPERS PERSONAL HOME CARE

Table of content: (NPI 1144523697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144523697 NPI number — ROPERS PERSONAL HOME CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROPERS PERSONAL HOME CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144523697
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 735
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOUNTSTOWN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32424-0735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-643-8607
Provider Business Mailing Address Fax Number:
850-674-5144

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17112 NW CHARLIE JOHNS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOUNTSTOWN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32424-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-643-8607
Provider Business Practice Location Address Fax Number:
850-674-5144
Provider Enumeration Date:
12/06/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ROPER
Authorized Official First Name:
JULIA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER / ALF
Authorized Official Telephone Number:
850-643-8607

Provider Taxonomy Codes

  • Taxonomy code: 3104A0625X , with the licence number:  AL-12 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 140805400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".