Healthcare Provider Details

I. General information

NPI: 1104545953
Provider Name (Legal Business Name): CARTERS CONFIDENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 09/20/2024
Certification Date: 09/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

678 SE BAYA DR
LAKE CITY FL
32025-6038
US

IV. Provider business mailing address

678 SE BAYA DR
LAKE CITY FL
32025-6038
US

V. Phone/Fax

Practice location:
  • Phone: 386-361-3839
  • Fax: 386-381-1099
Mailing address:
  • Phone: 386-361-3839
  • Fax: 386-381-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: BLENDA A JONES CARTER
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 386-438-4488