Healthcare Provider Details

I. General information

NPI: 1497302681
Provider Name (Legal Business Name): SAFETY HARBOR ADULT DAY CARE & ACTIVITY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2019
Last Update Date: 08/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3311 N POWERS DR
ORLANDO FL
32818-2242
US

IV. Provider business mailing address

PO BOX 683216
ORLANDO FL
32868-3216
US

V. Phone/Fax

Practice location:
  • Phone: 407-496-8869
  • Fax:
Mailing address:
  • Phone: 407-496-8869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. JASCINTH BROCKINGTON
Title or Position: ADMINISTRATOR
Credential: M.B.A.
Phone: 404-496-8869