1477784346 NPI number — PRECISE HOME COMPANIONS Eugenia Delphine Mays Medicaid provider

Table of content: Eugenia Delphine Mays Medicaid provider (NPI 1477784346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477784346 NPI number — PRECISE HOME COMPANIONS Eugenia Delphine Mays Medicaid provider

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRECISE HOME COMPANIONS
Provider Last Name:
Mays
Provider First Name:
Eugenia
Provider Middle Name:
Delphine
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Medicaid provider
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SAME
Provider Other Organization Name Type Code:
4
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:
1477784346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
82115TH ST EAST
Provider Second Line Business Mailing Address:
821
Provider Business Mailing Address City Name:
BRADENTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-747-8968
Provider Business Mailing Address Fax Number:
941-749-5669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
821 15TH ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRADENTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34208-2229
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-747-8968
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MAYS
Authorized Official First Name:
EUGENIA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
COMPANION OWNER
Authorized Official Telephone Number:
941-580-0622

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , with the licence number:  231014 , 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: 002843500 . 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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