Provider Demographics
NPI:1619575701
Name:TOP KNOTCH CARE LLC
Entity Type:Organization
Organization Name:TOP KNOTCH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:GLOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-564-1768
Mailing Address - Street 1:5340 W KENNEDY BLVD UNIT 436
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2434
Mailing Address - Country:US
Mailing Address - Phone:727-564-1768
Mailing Address - Fax:
Practice Address - Street 1:5340 W KENNEDY BLVD UNIT 436
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2434
Practice Address - Country:US
Practice Address - Phone:727-564-1768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL693546096Medicaid