Provider Demographics
NPI:1164813812
Name:DONNA ELAINE HARRELL
Entity Type:Organization
Organization Name:DONNA ELAINE HARRELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT FAMILY CARE HOME
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-466-1888
Mailing Address - Street 1:4915 CHURCHILL PL
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-6125
Mailing Address - Country:US
Mailing Address - Phone:727-466-1888
Mailing Address - Fax:727-466-6051
Practice Address - Street 1:4915 CHURCHILL PL
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-6125
Practice Address - Country:US
Practice Address - Phone:727-466-1888
Practice Address - Fax:727-466-6051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906715311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home