1073683553 NPI number — CHAPTERS HEALTH PALLIATIVE CARE, LLC

Table of content: (NPI 1073683553)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073683553 NPI number — CHAPTERS HEALTH PALLIATIVE CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHAPTERS HEALTH PALLIATIVE CARE, 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:
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:
1073683553
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12470 TELECOM DR
Provider Second Line Business Mailing Address:
SUITE 300 - ATTENTION: COMPLIANCE
Provider Business Mailing Address City Name:
TEMPLE TERRACE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33637-0904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-871-8200
Provider Business Mailing Address Fax Number:
813-871-8199

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12470 TELECOM DR
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
TEMPLE TERRACE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33637-0904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-871-8200
Provider Business Practice Location Address Fax Number:
813-871-8199
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUCCIARELLI
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
Authorized Official Title or Position:
STAFF ATTORNEY
Authorized Official Telephone Number:
813-871-8075

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1437336302 . This is a "PROVIDER - ZOE LEWIS MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1134156813 . This is a "PROVIDER - ANDREA MILLER MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1376071415 . This is a "PROVIDER - KERINE HINDS APRN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1538669627 . This is a "PROVIDER - RATCHADAKON TRAN APRN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1609115534 . This is a "PROVIDER - MATTHEW PETTIT APRN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1902134208 . This is a "PROVIDER - ISABEL BALES APRN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1083928592 . This is a "PROVIDER - RAVI SAMLAL DO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1144679176 . This is a "PROVIDER - MARIBETH ALLEN APRN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1275872459 . This is a "PROVIDER - JESSICA NOVAK APRN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1548294655 . This is a "PROVIDER - MARY ALFONO TORRES MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1194037770 . This is a "PROVIDER - ANTHONY JONES MD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1255758389 . This is a "PROVIDER - JULIE MARTINEZ APRN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1720276157 . This is a "PROVIDER - TERA GEARHART APRN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1669622858 . This is a "PROVIDER - KATHLEEN CURRAN APRN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1710428602 . This is a "PROVIDER - JESSICA BAILES APRN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1003360058 . This is a "PROVIDER - FITZWILLIAM MUSOKO ESELE APRN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 104111600 . 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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