1902995681 NPI number — CITRUS COUNTY ASSOCIATION FOR RETARDED CITIZENS, INC.

Table of content: (NPI 1902995681)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902995681 NPI number — CITRUS COUNTY ASSOCIATION FOR RETARDED CITIZENS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITRUS COUNTY ASSOCIATION FOR RETARDED CITIZENS, 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:
6
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:
1902995681
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 HEIGHTS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INVERNESS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34452-4571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-341-4633
Provider Business Mailing Address Fax Number:
352-341-4656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 HEIGHTS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INVERNESS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34452-4571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-341-4633
Provider Business Practice Location Address Fax Number:
352-341-4656
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
Authorized Official Title or Position:
ACCOUNTANT
Authorized Official Telephone Number:
352-795-5541

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 141192600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 141194200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 023514896 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 023514898 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114193400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 141191800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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