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General NPI Number Information
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NPI Number | 1710232269
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Entity Type | Organization
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Legal Business Name | MCCOY CARE INC.
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Dates
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Enumeration Date | 07/20/2012
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Last Update Date | 07/20/2012
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Provider Practice Location Address
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Address Line | 120 E 20TH AVE
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City | MOUNT DORA
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State | FL
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Zip | 32757-2869
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Country | US
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Telephone | 352-383-9770
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Fax | 352-735-1545
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Provider Business Mailing Address
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Address Line | 120 E 20TH AVE
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City | MOUNT DORA
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State | FL
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Zip | 32757-2869
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Country | US
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Telephone | 352-383-9770
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Fax | 352-735-1545
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Authorized Official
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Title or Position | PRESIDENT
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Name | CASEY MCCOY
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Credential |
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Telephone | 352-551-4322
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 9069
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License Number State | FL
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