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General NPI Number Information
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NPI Number | 1114449642
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Entity Type | Organization
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Legal Business Name | ACTIVE ADULT CARE, LLC
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 909 BRYAN RD
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City | BRANDON
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State | FL
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Zip | 33511-6145
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Country | US
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Telephone | 813-571-1227
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Fax | 813-571-1228
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Provider Business Mailing Address
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Address Line | 909 BRYAN RD
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City | BRANDON
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State | FL
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Zip | 33511-6145
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Country | US
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Telephone | 813-571-1227
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Fax | 813-571-1228
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Authorized Official
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Title or Position | MANAGER
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Name | MRS. CLAUDIA ALUR
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Credential | PT, DPT
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Telephone | 813-571-1227
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 9388
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License Number State | FL
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