Healthcare Provider Details

I. General information

NPI: 1992932297
Provider Name (Legal Business Name): PCM HEALTH CARE OF PINELLAS COUNTY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 E ORANGE ST
TARPON SPRINGS FL
34689-4352
US

IV. Provider business mailing address

1917 BROOKSTONE WAY
CLEARWATER FL
33760-1603
US

V. Phone/Fax

Practice location:
  • Phone: 727-937-9405
  • Fax:
Mailing address:
  • Phone: 727-647-1046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberAL4160
License Number StateFL

VIII. Authorized Official

Name: MS. PAULA KAREN COMER
Title or Position: PRESIDENT
Credential:
Phone: 727-937-9405