=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467113563
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEIGHBORHOOD CAREER ACADEMY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/02/2022
-----------------------------------------------------
Last Update Date | 01/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 949 JENKS AVE STE 17
-----------------------------------------------------
City | PANAMA CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32401-2585
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-771-4723
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2310 S HIGHWAY 77 STE 110-137
-----------------------------------------------------
City | LYNN HAVEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32444-4616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-771-4723
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | LAURONDA STAPLES
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 850-771-4723
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------