Healthcare Provider Details

I. General information

NPI: 1730006446
Provider Name (Legal Business Name): PORT CHARLOTTE ADULT DAYCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19700 COCHRAN BLVD STE D-1
PORT CHARLOTTE FL
33948-2032
US

IV. Provider business mailing address

2323 NE 26TH AVE STE 102
POMPANO BEACH FL
33062-1147
US

V. Phone/Fax

Practice location:
  • Phone: 941-291-0524
  • Fax: 941-291-0146
Mailing address:
  • Phone: 941-291-0524
  • Fax: 941-291-0146

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: NICHOLAS BASTO
Title or Position: OWNER
Credential:
Phone: 941-291-0524