Provider Demographics
NPI:1003374844
Name:CERTIFIED CARE SOURCES INC
Entity Type:Organization
Organization Name:CERTIFIED CARE SOURCES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-600-9193
Mailing Address - Street 1:7901 4TH ST N STE 101
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4359
Mailing Address - Country:US
Mailing Address - Phone:727-600-9193
Mailing Address - Fax:
Practice Address - Street 1:7901 4TH ST N STE 101
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4359
Practice Address - Country:US
Practice Address - Phone:727-600-9193
Practice Address - Fax:727-225-9558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-11
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care