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General NPI Number Information
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NPI Number | 1932853736
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Entity Type | Organization
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Legal Business Name | K2 ESCAPE INC
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Dates
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Enumeration Date | 02/09/2022
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Last Update Date | 02/09/2022
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Provider Practice Location Address
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Address Line | 1005 W BLOOMINGDALE AVE
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City | BRANDON
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State | FL
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Zip | 33511-7754
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Country | US
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Telephone | 813-440-7815
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 W BLOOMINGDALE AVE
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City | BRANDON
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State | FL
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Zip | 33511-7754
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Country | US
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Telephone | 813-440-7815
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ESSIE WILSON
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Credential |
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Telephone | 813-440-7815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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