1306099817 NPI number — AUTUMN HOME CARE OF NORTH CENTRAL FLORIDA LLC

Table of content: (NPI 1306099817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306099817 NPI number — AUTUMN HOME CARE OF NORTH CENTRAL FLORIDA LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUTUMN HOME CARE OF NORTH CENTRAL FLORIDA LLC
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:
1306099817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10773 70TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEMINOLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33772-6302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-398-4467
Provider Business Mailing Address Fax Number:
727-399-9788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13115 SPRING HILL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING HILL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34609-5052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-688-2557
Provider Business Practice Location Address Fax Number:
352-688-2558
Provider Enumeration Date:
10/28/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AMBROSE
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
727-398-4467

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  299993311 , 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)