MEDICARE: KUTE CARE SECOND CHANCE HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311ZA0620X	Adult Care Home Facility		FL
2	385HR2060X	Child Intellectual and/or Developmental Disabilities Respite Care		FL
3	347C00000X	Private Vehicle	M245785656880	FL
4	311Z00000X	Custodial Care Facility		FL

General Provider Information

NPI Number	:	1023209814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KUTE CARE SECOND CHANCE HOME

Provider Business Mailing Address
First Line	:	18946 TWINBERRY DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3418
Country	:	US
Telephone Number	:	813-528-6979
Fax Number	:

Provider Business Practice Location Address
First Line	:	18946 TWINBERRY DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33647-3418
Country	:	US
Telephone Number	:	813-528-6979
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. SUSAN ELIZABETH MCLEAN
Credential	:
Telephone Number	:	813-528-6979

Provider Enumeration Date	:	08/06/2007
Last Update Date	:	10/01/2013

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