Provider Demographics
NPI:1780435560
Name:FELYCIA LLC
Entity type:Organization
Organization Name:FELYCIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:WIDLYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:FLORISSANT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-850-6663
Mailing Address - Street 1:15410 WINTER BREEZE LN
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-2219
Mailing Address - Country:US
Mailing Address - Phone:813-850-6663
Mailing Address - Fax:
Practice Address - Street 1:15410 WINTER BREEZE LN
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-2219
Practice Address - Country:US
Practice Address - Phone:813-850-6663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FELYCIA LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114223900Medicaid