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General NPI Number Information
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NPI Number | 1750684809
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Entity Type | Organization
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Legal Business Name | HOME AGAIN OF SOUTHWEST FLORIDA,INC.
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 1357 RAMSDEL ST
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-2887
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Country | US
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Telephone | 941-743-4857
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Fax | 800-921-4989
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Provider Business Mailing Address
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Address Line | PO BOX 380183
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City | MURDOCK
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State | FL
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Zip | 33938-0183
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Country | US
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Telephone | 941-743-4857
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Fax | 800-921-4989
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANGELA ASHLEY
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Credential |
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Telephone | 941-743-4857
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State | FL
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