Provider Demographics
NPI:1609000827
Name:PAULETTE'S ADULT FAMILY HOME
Entity Type:Organization
Organization Name:PAULETTE'S ADULT FAMILY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/CNA
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALKER-SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-986-1011
Mailing Address - Street 1:10122 TIMMONS RD
Mailing Address - Street 2:
Mailing Address - City:THONOTOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:33592-3349
Mailing Address - Country:US
Mailing Address - Phone:813-986-1011
Mailing Address - Fax:813-982-2039
Practice Address - Street 1:10122 TIMMONS RD
Practice Address - Street 2:
Practice Address - City:THONOTOSASSA
Practice Address - State:FL
Practice Address - Zip Code:33592-3349
Practice Address - Country:US
Practice Address - Phone:813-986-1011
Practice Address - Fax:813-982-2039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000015100Medicaid