Healthcare Provider Details

I. General information

NPI: 1710232269
Provider Name (Legal Business Name): MCCOY CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 20TH AVE
MOUNT DORA FL
32757-2869
US

IV. Provider business mailing address

120 E 20TH AVE
MOUNT DORA FL
32757-2869
US

V. Phone/Fax

Practice location:
  • Phone: 352-383-9770
  • Fax: 352-735-1545
Mailing address:
  • Phone: 352-383-9770
  • Fax: 352-735-1545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9069
License Number StateFL

VIII. Authorized Official

Name: CASEY MCCOY
Title or Position: PRESIDENT
Credential:
Phone: 352-551-4322