MEDICARE: SAFETY HARBOR ADULT DAY CARE & ACTIVITY CENTER 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	261QA0600X	Adult Day Care Clinic/Center

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	:	1497302681
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAFETY HARBOR ADULT DAY CARE & ACTIVITY CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 683216
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32868-3216
Country	:	US
Telephone Number	:	407-496-8869
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 N POWERS DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32818-2242
Country	:	US
Telephone Number	:	407-496-8869
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. JASCINTH BROCKINGTON
Credential	:	M.B.A.
Telephone Number	:	404-496-8869

Provider Enumeration Date	:	08/22/2019
Last Update Date	:	08/22/2019

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