=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912160524
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WORD FOR THE WEEK, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2008
-----------------------------------------------------
Last Update Date | 07/03/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4656 COPPER LANE
-----------------------------------------------------
City | PLANT CITY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33566
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-752-4907
-----------------------------------------------------
Fax | 813-567-1229
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1776
-----------------------------------------------------
City | SEFFNER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33583-1776
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-752-4907
-----------------------------------------------------
Fax | 813-567-1229
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGING AGENT
-----------------------------------------------------
Name | GERALD WAYNE JACKSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-752-4907
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------