1134384563 NPI number — NEIGHBORLY CARE NETWORK

Table of content: (NPI 1134384563)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134384563 NPI number — NEIGHBORLY CARE NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIGHBORLY CARE NETWORK
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:
1134384563
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13945 EVERGREEN AVENUE
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:
33762-4525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-573-9444
Provider Business Mailing Address Fax Number:
727-288-5015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12425 28TH ST N
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ST PETERSBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33716-1844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-573-9444
Provider Business Practice Location Address Fax Number:
727-572-8214
Provider Enumeration Date:
07/24/2008

Additional Information

Authorized Official

Authorized Official Last Name:
POWERS
Authorized Official First Name:
JUDITH
Authorized Official Middle Name:
GOLDEN
Authorized Official Title or Position:
DIRECTOR OF MANAGED CARE
Authorized Official Telephone Number:
727-756-1009

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 015043614 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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