=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659612653
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHILDREN HAVING OPPORTUNITIES IN A CARING ENVIRONMENT INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2013
-----------------------------------------------------
Last Update Date | 03/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3512 HILLGROVE RD
-----------------------------------------------------
City | VALRICO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33596-8427
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-369-3341
-----------------------------------------------------
Fax | 813-333-7454
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1277
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33509-1277
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-369-3341
-----------------------------------------------------
Fax | 813-333-7454
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MR. TREVOR P NELSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-369-3341
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253J00000X
-----------------------------------------------------
Taxonomy Name | Foster Care Agency
-----------------------------------------------------
License Number | 100020064
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------