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General NPI Number Information
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NPI Number | 1801138003
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Entity Type | Organization
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Legal Business Name | PHYLLIS BAIRD ADULT FAMILY CARE HOME
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Dates
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Enumeration Date | 03/26/2013
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Last Update Date | 03/26/2013
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Provider Practice Location Address
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Address Line | 284 COMSTOCK ST
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City | PORT CHARLOTTE
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State | FL
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Zip | 33954-3627
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Country | US
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Telephone | 941-743-0778
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Fax |
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Provider Business Mailing Address
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Address Line | 284 COMSTOCK ST
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City | PORT CHARLOTTE
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State | FL
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Zip | 33954-3627
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PHYLLUS BAIRD
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Credential |
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Telephone | 941-743-0778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number | 3
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License Number State | FL
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