Healthcare Provider Details

I. General information

NPI: 1396722567
Provider Name (Legal Business Name): ENGLEWOOD ADULT CARE HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 PINE ST
ENGLEWOOD FL
34223-3948
US

IV. Provider business mailing address

280 PINE ST
ENGLEWOOD FL
34223-3948
US

V. Phone/Fax

Practice location:
  • Phone: 941-474-5563
  • Fax: 941-473-9722
Mailing address:
  • Phone: 941-474-5563
  • Fax: 941-473-9722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL7384
License Number StateFL

VIII. Authorized Official

Name: JANET MOYNIHAN
Title or Position: OWNER
Credential: R.N.
Phone: 941-474-5563