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General NPI Number Information
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NPI Number | 1629181391
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Entity Type | Organization
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Legal Business Name | CATHY'S ADULT FAMILY CARE HOME
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Dates
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Enumeration Date | 08/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 420 EL DORADO ST
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City | LAKELAND
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State | FL
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Zip | 33809-4284
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Country | US
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Telephone | 863-859-7804
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Fax | 863-859-7804
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Provider Business Mailing Address
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Address Line | 420 EL DORADO ST
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City | LAKELAND
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State | FL
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Zip | 33809-4284
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Country | US
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Telephone | 863-859-7804
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Fax | 863-859-7804
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Authorized Official
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Title or Position | OWNER
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Name | MRS. CATHERINE WHITE
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Credential |
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Telephone | 863-859-7804
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 6905749
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License Number State | FL
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