Provider Demographics
NPI:1619278256
Name:ANNETTE'S PROFESSIONAL CARE SERVICE,LLC
Entity Type:Organization
Organization Name:ANNETTE'S PROFESSIONAL CARE SERVICE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOE/ OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:A
Authorized Official - Last Name:GAINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-443-7058
Mailing Address - Street 1:PO BOX 1162
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:FL
Mailing Address - Zip Code:33834-1162
Mailing Address - Country:US
Mailing Address - Phone:863-443-7058
Mailing Address - Fax:863-658-2135
Practice Address - Street 1:5109 STURGEON DR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-1173
Practice Address - Country:US
Practice Address - Phone:863-443-7058
Practice Address - Fax:863-658-2135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-13
Last Update Date:2010-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251E00000XAgenciesHome Health
No252Y00000XAgenciesEarly Intervention Provider Agency
No253Z00000XAgenciesIn Home Supportive Care
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No347C00000XTransportation ServicesPrivate Vehicle
No347E00000XTransportation ServicesTransportation Broker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000630100Medicaid
FL002313600Medicaid
FL000309700Medicaid
FL002536200Medicaid
FL002313900Medicaid