1639335524 NPI number — AUTUMN HOME CARE OF SOUTH WESTERN FLORIDA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639335524 NPI number — AUTUMN HOME CARE OF SOUTH WESTERN FLORIDA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUTUMN HOME CARE OF SOUTH WESTERN 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:
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:
1639335524
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10773 70TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEMINOLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33772-6302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-398-4467
Provider Business Mailing Address Fax Number:
727-399-9788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4456 TAMIAMI TRL
Provider Second Line Business Practice Location Address:
SUITE A4
Provider Business Practice Location Address City Name:
PUNTA GORDA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33980-2101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-979-5184
Provider Business Practice Location Address Fax Number:
941-979-5237
Provider Enumeration Date:
07/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AMBROSE
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
727-398-4467

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  299993223 , 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)





Copyright © 2007-2024 www.npivalidator.com