Healthcare Provider Details

I. General information

NPI: 1356809198
Provider Name (Legal Business Name): MEDICAL FOSTER HOMES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9670 LUPINE AVE
ORLANDO FL
32824-8744
US

IV. Provider business mailing address

PO BOX 621883
ORLANDO FL
32862-1883
US

V. Phone/Fax

Practice location:
  • Phone: 321-622-0782
  • Fax:
Mailing address:
  • Phone: 321-622-0782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA LEDOUX
Title or Position: ADMINISTRATOR/OWNER
Credential: MD
Phone: 321-622-0782