Provider Demographics
NPI:1962629469
Name:NORTHWEST CARE CENTRE
Entity Type:Organization
Organization Name:NORTHWEST CARE CENTRE
Other - Org Name:EXCELSIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:GUCCIONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-798-3949
Mailing Address - Street 1:802 71ST ST NW
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-1515
Mailing Address - Country:US
Mailing Address - Phone:941-798-3949
Mailing Address - Fax:941-795-4780
Practice Address - Street 1:802 71ST ST NW
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-1515
Practice Address - Country:US
Practice Address - Phone:941-798-3949
Practice Address - Fax:941-795-4780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities