Provider Demographics
NPI:1649745399
Name:KATIE HAYNES
Entity Type:Organization
Organization Name:KATIE HAYNES
Other - Org Name:KATIE HAYNES
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER CAREGIVER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-276-2515
Mailing Address - Street 1:4123 WHITING DR SE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-4061
Mailing Address - Country:US
Mailing Address - Phone:727-276-2515
Mailing Address - Fax:
Practice Address - Street 1:4123 WHITING DR SE
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-4061
Practice Address - Country:US
Practice Address - Phone:727-276-2515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-09
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home