Healthcare Provider Details

I. General information

NPI: 1992409387
Provider Name (Legal Business Name): FANTA VILLA CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19135 US HIGHWAY 19 N APT B26
CLEARWATER FL
33764-3200
US

IV. Provider business mailing address

19135 US HIGHWAY 19 N APT B26
CLEARWATER FL
33764-3200
US

V. Phone/Fax

Practice location:
  • Phone: 727-815-5499
  • Fax:
Mailing address:
  • Phone: 727-815-5499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: FRANCESS BARCHUE
Title or Position: OWNER
Credential:
Phone: 727-815-5499