MEDICARE: FLORIDA ADULT CARE

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	385H00000X	Respite Care	9097	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366743072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA ADULT CARE

Provider Business Mailing Address
First Line	:	1504 S HARBOR CITY BLVD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-4654
Country	:	US
Telephone Number	:	321-676-3460
Fax Number	:	321-676-3461

Provider Business Practice Location Address
First Line	:	1504 S HARBOR CITY BLVD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-4654
Country	:	US
Telephone Number	:	321-676-3460
Fax Number	:	321-676-3461

Authorized Official
Title or Position	:	OWNER
Name	:	MARY ELIZABETH ROSENBLOOM
Credential	:	REGISTERED NURSE
Telephone Number	:	321-673-3460

Provider Enumeration Date	:	11/11/2010
Last Update Date	:	11/11/2010

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Directions to “FLORIDA ADULT CARE ” Practice Location

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