1154977668 NPI number — YES WE DO CARE INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154977668 NPI number — YES WE DO CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YES WE DO CARE INC
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:
1154977668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5726 LINCOLN CIR E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE WORTH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33463-6757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-889-9425
Provider Business Mailing Address Fax Number:
561-828-7627

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5726 LINCOLN CIR E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE WORTH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33463-6757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-889-9425
Provider Business Practice Location Address Fax Number:
561-828-7627
Provider Enumeration Date:
08/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
CAMILLE
Authorized Official First Name:
KETLY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
561-812-3976

Provider Taxonomy Codes

  • Taxonomy code: 376J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 102484500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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