Provider Demographics
NPI:1427225176
Name:SHATARA'S PASSION CARE,INC
Entity Type:Organization
Organization Name:SHATARA'S PASSION CARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-400-5795
Mailing Address - Street 1:5163 MOOSE CREEK CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-9304
Mailing Address - Country:US
Mailing Address - Phone:904-400-5795
Mailing Address - Fax:
Practice Address - Street 1:5163 MOOSE CREEK CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-9304
Practice Address - Country:US
Practice Address - Phone:904-400-5795
Practice Address - Fax:904-724-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691277098Medicaid
FL691277096Medicaid