Healthcare Provider Details

I. General information

NPI: 1326293283
Provider Name (Legal Business Name): FIRST CARE ASSISTANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2008
Last Update Date: 11/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 PINEBERRY DR APT. #101
BRANDON FL
33510-4922
US

IV. Provider business mailing address

828 PINEBERRY DR APT. #101
BRANDON FL
33510-4922
US

V. Phone/Fax

Practice location:
  • Phone: 813-401-4756
  • Fax: 813-662-4599
Mailing address:
  • Phone: 813-401-4756
  • Fax: 813-662-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number229476
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number229476
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number229476
License Number StateFL

VIII. Authorized Official

Name: MRS. IVETTE CAMARA
Title or Position: PRESIDENT
Credential:
Phone: 813-401-4756