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General NPI Number Information
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NPI Number | 1265735179
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Entity Type | Organization
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Legal Business Name | TIME OUT RESPITE CARE, INC.
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Dates
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Enumeration Date | 12/15/2010
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 24246 HARBORVIEW RD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-2232
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Country | US
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Telephone | 941-743-3883
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Fax | 941-743-4369
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Provider Business Mailing Address
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Address Line | 24246 HARBORVIEW RD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-2232
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Country | US
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Telephone | 941-743-3883
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Fax | 941-743-4369
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SHARON CHRISTINA HARTZELL
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Credential |
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Telephone | 941-743-3883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number | 089079
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 089079
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 385HR2065X
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Taxonomy Name | Child Physical Disabilities Respite Care
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License Number | 089079
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | 089079
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License Number State | FL
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