Healthcare Provider Details

I. General information

NPI: 1023209814
Provider Name (Legal Business Name): KUTE CARE SECOND CHANCE HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 10/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18946 TWINBERRY DR
TAMPA FL
33647-3418
US

IV. Provider business mailing address

18946 TWINBERRY DR
TAMPA FL
33647-3418
US

V. Phone/Fax

Practice location:
  • Phone: 813-528-6979
  • Fax:
Mailing address:
  • Phone: 813-528-6979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberM245785656880
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. SUSAN ELIZABETH MCLEAN
Title or Position: CEO
Credential:
Phone: 813-528-6979