Provider Demographics
NPI:1700363140
Name:CARING PALMS OF FLORIDA SUPPORTIVE AND DEVELOPMETNAL SERVICES
Entity Type:Organization
Organization Name:CARING PALMS OF FLORIDA SUPPORTIVE AND DEVELOPMETNAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-593-8047
Mailing Address - Street 1:630 BULLARD AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-3208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5598B MOSSEY OAK DR
Practice Address - Street 2:
Practice Address - City:MOLINO
Practice Address - State:FL
Practice Address - Zip Code:32577
Practice Address - Country:US
Practice Address - Phone:251-593-8047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-27
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental DisabilitiesGroup - Single Specialty
No373H00000XNursing Service Related ProvidersDay Training/Habilitation SpecialistGroup - Single Specialty