Provider Demographics
NPI:1982017497
Name:ADDIE'S ADULT FAMILY CARE
Entity Type:Organization
Organization Name:ADDIE'S ADULT FAMILY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:CELESTINE
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-778-2845
Mailing Address - Street 1:7608 COPELAND RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3205
Mailing Address - Country:US
Mailing Address - Phone:813-778-8245
Mailing Address - Fax:
Practice Address - Street 1:7608 COPELAND RD
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-3205
Practice Address - Country:US
Practice Address - Phone:813-778-8245
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-03
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906678311ZA0620X
FL234669372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care HomeGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty