MEDICARE: WALTER TOPIC ADULT FAMILY CARE HOME

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	311ZA0620X	Adult Care Home Facility	6905782	FL

General Provider Information

NPI Number	:	1790027241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WALTER TOPIC ADULT FAMILY CARE HOME

Provider Business Mailing Address
First Line	:	4231 ERINDALE DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33903-5029
Country	:	US
Telephone Number	:	239-656-0019
Fax Number	:	239-656-0019

Provider Business Practice Location Address
First Line	:	4231 ERINDALE DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33903-5029
Country	:	US
Telephone Number	:	239-656-0019
Fax Number	:	239-656-0019

Authorized Official
Title or Position	:	OWNER
Name	:	MR. WALTER TOPIC
Credential	:
Telephone Number	:	239-656-0019

Provider Enumeration Date	:	03/22/2013
Last Update Date	:	03/22/2013

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