=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255584868
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFE CARE COMPANIONS OF NORTHWEST FLORIDA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2008
-----------------------------------------------------
Last Update Date | 09/10/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8510 SONNYBOY LN
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32514-3436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-324-4617
-----------------------------------------------------
Fax | 850-462-9324
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8510 SONNYBOY LANE
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32514
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-324-4617
-----------------------------------------------------
Fax | 850-462-9324
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MS. PRISCILLA C BALDWIN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 850-324-4617
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251G00000X
-----------------------------------------------------
Taxonomy Name | Community Based Hospice Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 232860
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------