Provider Demographics
NPI:1134746381
Name:MICKEYCAREPLUS SERVICE LLC
Entity type:Organization
Organization Name:MICKEYCAREPLUS SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-412-9959
Mailing Address - Street 1:1717 E CAYUGA ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-6025
Mailing Address - Country:US
Mailing Address - Phone:813-412-9959
Mailing Address - Fax:813-435-2152
Practice Address - Street 1:1717 E CAYUGA ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-6025
Practice Address - Country:US
Practice Address - Phone:813-412-9959
Practice Address - Fax:813-435-2152
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MICKEYCAREPLUS SERVICE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-02
Last Update Date:2020-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility