Provider Demographics
NPI:1184688038
Name:ANN MARIE NELSON
Entity Type:Organization
Organization Name:ANN MARIE NELSON
Other - Org Name:NELSON ADULT FAMILY CARE HOME
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:PROVIDER
Authorized Official - Phone:407-293-8080
Mailing Address - Street 1:4784 SANOMA VLG
Mailing Address - Street 2:PRIVATE
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1292
Mailing Address - Country:US
Mailing Address - Phone:407-293-8080
Mailing Address - Fax:407-293-8080
Practice Address - Street 1:4784 SANOMA VLG
Practice Address - Street 2:PRIVATE
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-1292
Practice Address - Country:US
Practice Address - Phone:407-293-8080
Practice Address - Fax:407-293-8080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6905925320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL32Medicare UPIN