Provider Demographics
NPI:1346012721
Name:JIMENEZ & NAZARIO LLC
Entity Type:Organization
Organization Name:JIMENEZ & NAZARIO LLC
Other - Org Name:SILVER HEART ADULT DAY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:NAZARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-507-1245
Mailing Address - Street 1:11231 GOLD COMPASS ST
Mailing Address - Street 2:
Mailing Address - City:GIBSONTON
Mailing Address - State:FL
Mailing Address - Zip Code:33534-5698
Mailing Address - Country:US
Mailing Address - Phone:813-507-1245
Mailing Address - Fax:
Practice Address - Street 1:302 S COLLINS ST
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33563-5534
Practice Address - Country:US
Practice Address - Phone:813-507-1245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No174200000XOther Service ProvidersMeals
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTBDMedicaid