Provider Demographics
NPI:1417204561
Name:ADULT CARE AND RESPITE, INC.
Entity Type:Organization
Organization Name:ADULT CARE AND RESPITE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOPKINS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:727-233-3766
Mailing Address - Street 1:175 1ST. ST. S. SUITE 505
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4525
Mailing Address - Country:US
Mailing Address - Phone:727-233-3766
Mailing Address - Fax:727-233-3766
Practice Address - Street 1:8950 9TH ST N STE 109
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-3001
Practice Address - Country:US
Practice Address - Phone:727-233-3766
Practice Address - Fax:727-233-3766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2817272261QA0600X, 311500000X, 385H00000X
FL1417204561261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1417204561Medicare PIN