1932418456 NPI number — ACKERMAN ENTERPRISES, LLC

Table of content: (NPI 1932418456)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932418456 NPI number — ACKERMAN ENTERPRISES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACKERMAN ENTERPRISES, 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:
CURLEW CARE HOME 1
Provider Other Organization Name Type Code:
3
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:
1932418456
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1722 CURLEW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUNEDIN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34698-9216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-785-8350
Provider Business Mailing Address Fax Number:
727-784-4740

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1722 CURLEW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DUNEDIN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34698-9216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-785-8350
Provider Business Practice Location Address Fax Number:
727-784-4740
Provider Enumeration Date:
10/01/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ACKERMAN
Authorized Official First Name:
AUDRA
Authorized Official Middle Name:
RACHELLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
727-458-8607

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  5922 , 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: 684498700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".