Provider Demographics
NPI:1750530994
Name:PATRICIA A. CARSON
Entity type:Organization
Organization Name:PATRICIA A. CARSON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-504-8206
Mailing Address - Street 1:191 PATRICE HOPE ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7342
Mailing Address - Country:US
Mailing Address - Phone:352-504-8206
Mailing Address - Fax:352-314-0039
Practice Address - Street 1:191 PATRICE HOPE ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7342
Practice Address - Country:US
Practice Address - Phone:352-504-8206
Practice Address - Fax:352-314-0039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL692951696251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692951698OtherPROVIDER MEDICAID NUMBER
FL692951696OtherPROVIDER MEDICAID NUMBER