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General NPI Number Information
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NPI Number | 1578192910
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Entity Type | Organization
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Legal Business Name | LITTLE DEBBIE'S SECOND CHANCE HOMES FLORIDA
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Dates
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Enumeration Date | 04/07/2020
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Last Update Date | 04/07/2020
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Provider Practice Location Address
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Address Line | 8379 GASPARILLA RD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33981-2819
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Country | US
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Telephone | 305-509-9496
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Fax | 678-550-6491
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Provider Business Mailing Address
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Address Line | 4280 MEMORIAL DR STE C
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City | DECATUR
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State | GA
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Zip | 30032-1216
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Country | US
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Telephone | 305-509-9496
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Fax | 678-550-6491
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Authorized Official
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Title or Position | CEO
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Name | MRS. LAKISHA STIGGERS
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Credential |
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Telephone | 305-509-9496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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