Provider Demographics
NPI:1265735179
Name:TIME OUT RESPITE CARE, INC.
Entity type:Organization
Organization Name:TIME OUT RESPITE CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:CHRISTINA
Authorized Official - Last Name:HARTZELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-743-3883
Mailing Address - Street 1:24246 HARBORVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33980-2232
Mailing Address - Country:US
Mailing Address - Phone:941-743-3883
Mailing Address - Fax:941-743-4369
Practice Address - Street 1:24246 HARBORVIEW RD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-2232
Practice Address - Country:US
Practice Address - Phone:941-743-3883
Practice Address - Fax:941-743-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL089079251C00000X, 253Z00000X, 385HR2065X, 343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No253Z00000XAgenciesIn Home Supportive Care
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL347800000XMedicaid
FL251C00000XMedicaid
FL385H00000XMedicaid
FL253200000XMedicaid