MEDICARE: TAKE A BREAK BABYSITTING, INC

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	253Z00000X	In Home Supportive Care Agency
2	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1902342207
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TAKE A BREAK BABYSITTING, INC

Provider Business Mailing Address
First Line	:	1226 E COMANCHE AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-7226
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1226 E COMANCHE AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-7226
Country	:	US
Telephone Number	:	813-283-8224
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JESSICA SADE ANDREWS
Credential	:	M.A.
Telephone Number	:	813-575-0822

Provider Enumeration Date	:	01/10/2017
Last Update Date	:	01/10/2017

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