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General NPI Number Information
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NPI Number | 1639869019
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Entity Type | Organization
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Legal Business Name | HOME CENTERED CNA CARE INC
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Dates
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Enumeration Date | 05/10/2023
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Last Update Date | 05/10/2023
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Provider Practice Location Address
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Address Line | 1517 W GARDEN ST
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City | PENSACOLA
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State | FL
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Zip | 32502-4508
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Country | US
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Telephone | 850-438-1122
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Fax | 850-438-1414
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Provider Business Mailing Address
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Address Line | 1517 W GARDEN ST
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City | PENSACOLA
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State | FL
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Zip | 32502-4508
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Country | US
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Telephone | 850-438-1122
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Fax | 850-438-1414
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARY ANN CRUMLISH
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Credential | PA
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Telephone | 850-438-1122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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