Provider Demographics
NPI:1669018719
Name:CAZEAU ADULT FAMILY CARE HOME
Entity Type:Organization
Organization Name:CAZEAU ADULT FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHELET
Authorized Official - Middle Name:
Authorized Official - Last Name:CAZEAU
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BS, CWCN
Authorized Official - Phone:551-216-5300
Mailing Address - Street 1:724 CHINA BERRY CIR # 1
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-3908
Mailing Address - Country:US
Mailing Address - Phone:551-216-5300
Mailing Address - Fax:
Practice Address - Street 1:724 CHINA BERRY CIR # 1
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-3908
Practice Address - Country:US
Practice Address - Phone:551-216-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103536700Medicaid