=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669886305
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADKORE FAMILY CARE CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2014
-----------------------------------------------------
Last Update Date | 06/19/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1081 WP BALL BLVD
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32771-7201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-328-7595
-----------------------------------------------------
Fax | 407-328-7372
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1081 WP BALL BLVD
-----------------------------------------------------
City | SANFORD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32771-7201
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-328-7595
-----------------------------------------------------
Fax | 407-328-7372
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MELISA AYALA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 407-328-7595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------