Provider Demographics
NPI:1750711768
Name:LIDEYSA PATIENT CARE INC.
Entity type:Organization
Organization Name:LIDEYSA PATIENT CARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LIDEYSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLEJAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-321-1880
Mailing Address - Street 1:10950 GUILFORD RD
Mailing Address - Street 2:
Mailing Address - City:MINNEOLA
Mailing Address - State:FL
Mailing Address - Zip Code:34715-9087
Mailing Address - Country:US
Mailing Address - Phone:352-321-1880
Mailing Address - Fax:
Practice Address - Street 1:10950 GUILFORD RD
Practice Address - Street 2:
Practice Address - City:MINNEOLA
Practice Address - State:FL
Practice Address - Zip Code:34715-9087
Practice Address - Country:US
Practice Address - Phone:352-321-1880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906577311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home