=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194330803
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE 1ST OF ORLANDO INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2020
-----------------------------------------------------
Last Update Date | 10/23/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2211 LEE RD STE 205A
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32789-1846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-622-0589
-----------------------------------------------------
Fax | 888-506-5776
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2211 LEE RD STE 205A
-----------------------------------------------------
City | WINTER PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32789-1846
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-622-0589
-----------------------------------------------------
Fax | 888-506-5776
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LADY SERVILLAS
-----------------------------------------------------
Credential | RN/PT
-----------------------------------------------------
Telephone | 305-318-5115
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------