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General NPI Number Information
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NPI Number | 1992056873
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Entity Type | Organization
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Legal Business Name | CARE CLUB OF COLLIER COUNTY, INC.
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Dates
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Enumeration Date | 10/02/2012
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 1800 SANTA BARBARA BLVD
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City | NAPLES
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State | FL
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Zip | 34116-5444
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Country | US
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Telephone | 239-353-1994
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Fax | 239-455-8507
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Provider Business Mailing Address
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Address Line | 1800 SANTA BARBARA BLVD
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City | NAPLES
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State | FL
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Zip | 34116-5444
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Country | US
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Telephone | 239-353-1994
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Fax | 239-455-8507
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Authorized Official
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Title or Position | EXECTUVIE DIRECTOR
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Name | LUANNE WAHLSTROM
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Credential | LPN
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Telephone | 239-353-1994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | AD8750
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License Number State | FL
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