Provider Demographics
NPI:1326637232
Name:MCBRIDE, DELORES
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 MEADOWBROOK ST
Mailing Address - Street 2:
Mailing Address - City:LAKE PLACID
Mailing Address - State:FL
Mailing Address - Zip Code:33852-5723
Mailing Address - Country:US
Mailing Address - Phone:863-243-2896
Mailing Address - Fax:863-531-3572
Practice Address - Street 1:1502 MEADOWBROOK ST
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-5723
Practice Address - Country:US
Practice Address - Phone:863-243-2896
Practice Address - Fax:863-531-3572
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6907046372500000X, 311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No372500000XNursing Service Related ProvidersChore ProviderGroup - Single Specialty