=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528942265
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NADINE'S ADULT FAMILY HOME
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2025
-----------------------------------------------------
Last Update Date | 08/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 317 PENNFIELD ST
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33974-9495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-399-2744
-----------------------------------------------------
Fax | 239-399-2744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 317 PENNFIELD ST
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33974-9495
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-399-2744
-----------------------------------------------------
Fax | 239-399-2744
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NADINE SINGH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 239-399-2744
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 311ZA0620X
-----------------------------------------------------
Taxonomy Name | Adult Care Home Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------