Provider Demographics
NPI:1518668276
Name:MY EXTENDED FAMILY ASSISTED LIVING
Entity Type:Organization
Organization Name:MY EXTENDED FAMILY ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BONIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAPTISTE
Authorized Official - Suffix:
Authorized Official - Credentials:MNGR
Authorized Official - Phone:239-285-3990
Mailing Address - Street 1:5426 TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34113-7859
Mailing Address - Country:US
Mailing Address - Phone:239-285-3990
Mailing Address - Fax:
Practice Address - Street 1:5426 TEXAS AVE
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-7859
Practice Address - Country:US
Practice Address - Phone:239-285-3990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL882736455OtherBLUE CROSS BLUE SHIELD
FL882736455OtherUNITED HEALTHCARE