Provider Demographics
NPI:1639869019
Name:HOME CENTERED CNA CARE INC
Entity Type:Organization
Organization Name:HOME CENTERED CNA CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CRUMLISH
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:850-438-1122
Mailing Address - Street 1:1517 W GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-4508
Mailing Address - Country:US
Mailing Address - Phone:850-438-1122
Mailing Address - Fax:850-438-1414
Practice Address - Street 1:1517 W GARDEN ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-4508
Practice Address - Country:US
Practice Address - Phone:850-438-1122
Practice Address - Fax:850-438-1414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-10
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty