Provider Demographics
NPI:1649613001
Name:RADIKA SIMS ADULT FAMILY CARE HOME, LLC
Entity type:Organization
Organization Name:RADIKA SIMS ADULT FAMILY CARE HOME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RADIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-494-8785
Mailing Address - Street 1:720 CRISTELLE JEAN DR
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-7930
Mailing Address - Country:US
Mailing Address - Phone:813-494-8785
Mailing Address - Fax:813-419-4327
Practice Address - Street 1:720 CRISTELLE JEAN DR
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-7930
Practice Address - Country:US
Practice Address - Phone:813-494-8785
Practice Address - Fax:813-419-4327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-16
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906519311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004510200Medicaid