Healthcare Provider Details

I. General information

NPI: 1417204561
Provider Name (Legal Business Name): ADULT CARE AND RESPITE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2012
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8950 9TH ST N STE 109
ST PETERSBURG FL
33702-3001
US

IV. Provider business mailing address

175 1ST. ST. S. SUITE 505
ST PETERSBURG FL
33701-4525
US

V. Phone/Fax

Practice location:
  • Phone: 727-233-3766
  • Fax: 727-233-3766
Mailing address:
  • Phone: 727-233-3766
  • Fax: 727-233-3766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberRN2817272
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number1417204561
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberRN2817272
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberRN2817272
License Number StateFL

VIII. Authorized Official

Name: MR. GAVIN J HOPKINS
Title or Position: PRESIDENT
Credential: RN
Phone: 727-233-3766