MEDICARE: MCCLAIN, INCORPORATED

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	251C00000X	Developmentally Disabled Services Day Training Agency

General Provider Information

NPI Number	:	1942504568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCCLAIN, INCORPORATED

Provider Business Mailing Address
First Line	:	7211 N DALE MABRY HWY
Second Line	:	STE.#210
City	:	TAMPA
State	:	FL
Zip	:	33614-2669
Country	:	US
Telephone Number	:	813-930-0088
Fax Number	:	813-930-9933

Provider Business Practice Location Address
First Line	:	7211 N DALE MABRY HWY
Second Line	:	STE.#210
City	:	TAMPA
State	:	FL
Zip	:	33614-2669
Country	:	US
Telephone Number	:	813-930-0088
Fax Number	:	813-930-9933

Authorized Official
Title or Position	:	PRESIDENT BOD
Name	:	MRS. MARY E NELSON
Credential	:
Telephone Number	:	813-300-1634

Provider Enumeration Date	:	12/23/2010
Last Update Date	:	12/23/2010

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