=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376054551
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EMBRACE OF CLEARWATER, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/16/2017
-----------------------------------------------------
Last Update Date | 10/16/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1621 N HIGHLAND AVE
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33755-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-228-4540
-----------------------------------------------------
Fax | 727-270-9686
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1621 N HIGHLAND AVE
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33755-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-228-4540
-----------------------------------------------------
Fax | 727-270-9686
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JACQUELINE DELAROSA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-228-4540
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------