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General NPI Number Information
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NPI Number | 1982017497
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Entity Type | Organization
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Legal Business Name | ADDIE'S ADULT FAMILY CARE
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Dates
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Enumeration Date | 06/03/2014
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Last Update Date | 01/20/2017
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Provider Practice Location Address
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Address Line | 7608 COPELAND RD
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City | ODESSA
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State | FL
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Zip | 33556-3205
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Country | US
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Telephone | 813-778-8245
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Fax |
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Provider Business Mailing Address
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Address Line | 7608 COPELAND RD
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City | ODESSA
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State | FL
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Zip | 33556-3205
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Country | US
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Telephone | 813-778-8245
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Fax |
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Authorized Official
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Title or Position | ADMISTRATOR
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Name | MS. MICHELE CELESTINE JAMES
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Credential |
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Telephone | 813-778-2845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 234669
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 234669
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 6906678
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License Number State | FL
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