Healthcare Provider Details

I. General information

NPI: 1992056873
Provider Name (Legal Business Name): CARE CLUB OF COLLIER COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 SANTA BARBARA BLVD
NAPLES FL
34116-5444
US

IV. Provider business mailing address

1800 SANTA BARBARA BLVD
NAPLES FL
34116-5444
US

V. Phone/Fax

Practice location:
  • Phone: 239-353-1994
  • Fax: 239-455-8507
Mailing address:
  • Phone: 239-353-1994
  • Fax: 239-455-8507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberAD8750
License Number StateFL

VIII. Authorized Official

Name: LUANNE WAHLSTROM
Title or Position: EXECTUVIE DIRECTOR
Credential: LPN
Phone: 239-353-1994