1417232646 NPI number — FAMILY OPTIONS OF FLORIDA, LLC

Table of content: (NPI 1417232646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417232646 NPI number — FAMILY OPTIONS OF FLORIDA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY OPTIONS OF FLORIDA, 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:
1417232646
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12650 WORLD PLAZA LN
Provider Second Line Business Mailing Address:
BLDG 72, STE 1
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33907-4077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-275-0605
Provider Business Mailing Address Fax Number:
239-275-3429

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12650 WORLD PLAZA LN
Provider Second Line Business Practice Location Address:
BLDG 72, STE 1
Provider Business Practice Location Address City Name:
FORT MYERS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33907-4077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-275-0605
Provider Business Practice Location Address Fax Number:
239-275-3429
Provider Enumeration Date:
10/19/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MODELL-DION
Authorized Official First Name:
JILL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
239-275-0605

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  232181 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X , with the licence number: 9181 , 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)





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