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General NPI Number Information
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NPI Number | 1063803880
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Entity Type | Organization
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Legal Business Name | COMMUNITY AGING & RETIREMENT SERVICES, INC
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Dates
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Enumeration Date | 02/16/2015
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Last Update Date | 02/16/2015
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Provider Practice Location Address
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Address Line | 3940 CANOGA PARK DR
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City | BRANDON
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State | FL
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Zip | 33511
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Country | US
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Telephone | 813-330-7964
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Fax |
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Provider Business Mailing Address
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Address Line | 12417 CLOCK TOWER PKWY
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City | HUDSON
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State | FL
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Zip | 34667-2411
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Country | US
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Telephone | 727-862-9291
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | WILLIAM AYCRIGG
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Credential |
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Telephone | 727-862-9291
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 9288
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License Number State | FL
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