Provider Demographics
NPI:1417232646
Name:FAMILY OPTIONS OF FLORIDA, LLC
Entity Type:Organization
Organization Name:FAMILY OPTIONS OF FLORIDA, LLC
Other - Org Name:FAMILY OPTIONS OF FLORIDA ADULT DAY CARE CEBTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:MODELL-DION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-275-0605
Mailing Address - Street 1:12650 WORLD PLAZA LN
Mailing Address - Street 2:BLDG 72, STE 1
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4077
Mailing Address - Country:US
Mailing Address - Phone:239-275-0605
Mailing Address - Fax:239-275-3429
Practice Address - Street 1:12650 WORLD PLAZA LN
Practice Address - Street 2:BLDG 72, STE 1
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4077
Practice Address - Country:US
Practice Address - Phone:239-275-0605
Practice Address - Fax:239-275-3429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-19
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232181253Z00000X
FL9181261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No253Z00000XAgenciesIn Home Supportive Care