MEDICARE: MICKEYCAREPLUS SERVICE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1134746381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICKEYCAREPLUS SERVICE LLC

Provider Business Mailing Address
First Line	:	1717 E CAYUGA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-6025
Country	:	US
Telephone Number	:	813-412-9959
Fax Number	:	813-435-2152

Provider Business Practice Location Address
First Line	:	1717 E CAYUGA ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-6025
Country	:	US
Telephone Number	:	813-412-9959
Fax Number	:	813-435-2152

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MISS EMILY JEAN MURPHY
Credential	:
Telephone Number	:	813-412-9959

Provider Enumeration Date	:	07/02/2020
Last Update Date	:	07/03/2020

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Directions to “MICKEYCAREPLUS SERVICE LLC ” Practice Location

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