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General NPI Number Information
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NPI Number | 1124587753
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Entity Type | Organization
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Legal Business Name | THERESA HOME CARE, INC.
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Dates
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Enumeration Date | 03/13/2019
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Last Update Date | 03/13/2019
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Provider Practice Location Address
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Address Line | 485 MAPLE WAY
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City | SAFETY HARBOR
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State | FL
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Zip | 34695-2959
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Country | US
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Telephone | 727-492-8371
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 326
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City | SAFETY HARBOR
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State | FL
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Zip | 34695-0326
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Country | US
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Telephone | 727-492-8371
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | THERESA GONZALES
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Credential |
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Telephone | 727-492-8371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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