1013377811 NPI number — NEIGHBORLY CARE NETWORK, INC.

Table of content: (NPI 1013377811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013377811 NPI number — NEIGHBORLY CARE NETWORK, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIGHBORLY CARE NETWORK, 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:
1013377811
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5225 TECH DATA DR STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33760-3133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-573-9444
Provider Business Mailing Address Fax Number:
727-205-7793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11095 131ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LARGO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33774-4727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-593-1253
Provider Business Practice Location Address Fax Number:
727-593-5873
Provider Enumeration Date:
03/07/2016

Additional Information

Authorized Official

Authorized Official Last Name:
LOMAKA
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
727-573-9444

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  8944 , 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: 106632700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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