1417024472 NPI number — MANILA HOMECARE

Table of content: (NPI 1417024472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417024472 NPI number — MANILA HOMECARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANILA HOMECARE
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:
1417024472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
613 5TH AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LARGO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-667-4958
Provider Business Mailing Address Fax Number:
727-581-7351

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
613 5TH AVE SE
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:
33771
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-667-4958
Provider Business Practice Location Address Fax Number:
727-581-7351
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEWCOMB
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PROVIDER
Authorized Official Telephone Number:
727-667-4958

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  229837 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253J00000X , with the licence number: 37193FC , 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: $$$$$$$$$ . This is a "SOCIAL SECURITY NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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