Healthcare Provider Details

I. General information

NPI: 1710378351
Provider Name (Legal Business Name): ESCORBIS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2015
Last Update Date: 02/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11313 POSSUM TRL
PORT RICHEY FL
34668-2040
US

IV. Provider business mailing address

11313 POSSUM TRL
PORT RICHEY FL
34668-2040
US

V. Phone/Fax

Practice location:
  • Phone: 813-507-2195
  • Fax: 727-857-7413
Mailing address:
  • Phone: 813-507-2195
  • Fax: 727-857-7413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number232404
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number6906648
License Number StateFL

VIII. Authorized Official

Name: MRS. FRANCINE CHERY
Title or Position: ADMINISTRATOR
Credential:
Phone: 727-857-7413