Healthcare Provider Details

I. General information

NPI: 1942487046
Provider Name (Legal Business Name): YVONNE R HALL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 02/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 EASTLAKE CLUB DR
OLDSMAR FL
34677-2472
US

IV. Provider business mailing address

523 EASTLAKE CLUB DR
OLDSMAR FL
34677-2472
US

V. Phone/Fax

Practice location:
  • Phone: 352-438-9242
  • Fax: 727-772-5675
Mailing address:
  • Phone: 352-438-9242
  • Fax: 727-772-5675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number693593100
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MS. YVONNE RENEE HALL
Title or Position: OWNER
Credential:
Phone: 352-438-9242