Healthcare Provider Details

I. General information

NPI: 1184902157
Provider Name (Legal Business Name): MR. DAVID CHRISTOPHER WADE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 02/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4623 EBONY ST
ORLANDO FL
32811-3823
US

IV. Provider business mailing address

4623 EBONY ST
ORLANDO FL
32811-3823
US

V. Phone/Fax

Practice location:
  • Phone: 407-990-6333
  • Fax: 321-206-4502
Mailing address:
  • Phone: 407-990-6333
  • Fax: 321-206-4502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number007902900
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number003905100
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number232909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: