Provider Demographics
NPI:1871836908
Name:ADULT FAMILY HOME CARE, INC.
Entity Type:Organization
Organization Name:ADULT FAMILY HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:G
Authorized Official - Last Name:LAIDLAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-951-2887
Mailing Address - Street 1:2052-54 SYRACUSE COURT
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905
Mailing Address - Country:US
Mailing Address - Phone:321-951-2887
Mailing Address - Fax:321-327-5000
Practice Address - Street 1:2052 SYRACUSE CT NE
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3923
Practice Address - Country:US
Practice Address - Phone:321-951-2887
Practice Address - Fax:321-327-5000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2013-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6905399311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home