Provider Demographics
NPI:1649279589
Name:PENSACOLA CARE INC.
Entity type:Organization
Organization Name:PENSACOLA CARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:FINNERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-862-0108
Mailing Address - Street 1:113 BARKS DR
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-6713
Mailing Address - Country:US
Mailing Address - Phone:850-862-0108
Mailing Address - Fax:850-862-7103
Practice Address - Street 1:113 BARKS DR
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-6713
Practice Address - Country:US
Practice Address - Phone:850-862-0108
Practice Address - Fax:850-862-7103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4024096320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities