Provider Demographics
NPI:1629195284
Name:NEIGHBORLY CARE NETWORK
Entity Type:Organization
Organization Name:NEIGHBORLY CARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LOMAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-573-9444
Mailing Address - Street 1:13945 EVERGREEN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-4525
Mailing Address - Country:US
Mailing Address - Phone:727-573-9444
Mailing Address - Fax:
Practice Address - Street 1:12425 28TH ST N
Practice Address - Street 2:SUITE 200
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33716-1844
Practice Address - Country:US
Practice Address - Phone:727-573-9444
Practice Address - Fax:727-572-8214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNA261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690596000Medicaid