=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881255024
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARTERS ULTIMATE CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/27/2019
-----------------------------------------------------
Last Update Date | 11/19/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2806 W NEWTON RD
-----------------------------------------------------
City | AVON PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33825-9126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-257-0783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2806 W NEWTON RD
-----------------------------------------------------
City | AVON PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33825-9126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-657-3306
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | SONIA D CARTER
-----------------------------------------------------
Credential | HHA
-----------------------------------------------------
Telephone | 863-657-3306
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------