1295032241 NPI number — GOLD CARE HOME HEALTH SERVICES, INC

Table of content: (NPI 1295032241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295032241 NPI number — GOLD CARE HOME HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLD CARE HOME HEALTH SERVICES, 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:
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:
1295032241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1502 W BUSCH BLVD
Provider Second Line Business Mailing Address:
SUITE E
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33612-7668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-443-5219
Provider Business Mailing Address Fax Number:
813-443-5220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1502 W BUSCH BLVD
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33612-7668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-443-5219
Provider Business Practice Location Address Fax Number:
813-443-5220
Provider Enumeration Date:
02/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA-LORENZO
Authorized Official First Name:
PILAR
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO/ADMIN
Authorized Official Telephone Number:
813-443-5219

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  299993825 , 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: 004053200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10-9758 . This is a "CMS CERTIFICATION NUMBER (CCN)" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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