Provider Demographics
NPI:1245404250
Name:MARCIA A. HOWELL
Entity Type:Organization
Organization Name:MARCIA A. HOWELL
Other - Org Name:CARNELIAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-505-0454
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-0321
Mailing Address - Country:US
Mailing Address - Phone:813-505-0454
Mailing Address - Fax:813-926-4304
Practice Address - Street 1:17305 BLOOMING FIELDS DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34638-7222
Practice Address - Country:US
Practice Address - Phone:813-505-0454
Practice Address - Fax:813-926-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692043896Medicaid