Healthcare Provider Details

I. General information

NPI: 1043831696
Provider Name (Legal Business Name): WILSONS CARING PLACE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5609 US HWY 19 STE G
NEW PORT RICHEY FL
34652-3754
US

IV. Provider business mailing address

PO BOX 864
PORT RICHEY FL
34673-0864
US

V. Phone/Fax

Practice location:
  • Phone: 727-851-3949
  • Fax: 866-675-0558
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY WILSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 727-851-3949