=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003159138
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J&C CHOICE HOME SOLUTIONS, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2013
-----------------------------------------------------
Last Update Date | 03/27/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1480 WINSTON RD
-----------------------------------------------------
City | MAITLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32751-3650
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-972-2418
-----------------------------------------------------
Fax | 321-972-2447
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 624 MAPLE OAK CIR UNIT 104
-----------------------------------------------------
City | ALTAMONTE SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32701-6361
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-415-8038
-----------------------------------------------------
Fax | 321-972-2447
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CATHERINE C SEMYCK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-415-8038
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL12166
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------