Healthcare Provider Details

I. General information

NPI: 1144523697
Provider Name (Legal Business Name): ROPERS PERSONAL HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2010
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17112 NW CHARLIE JOHNS ST
BLOUNTSTOWN FL
32424-1308
US

IV. Provider business mailing address

PO BOX 735
BLOUNTSTOWN FL
32424-0735
US

V. Phone/Fax

Practice location:
  • Phone: 850-643-8607
  • Fax: 850-674-5144
Mailing address:
  • Phone: 850-643-8607
  • Fax: 850-674-5144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL-12
License Number StateFL

VIII. Authorized Official

Name: JULIA ANN ROPER
Title or Position: OWNER / ALF
Credential:
Phone: 850-643-8607