Provider Demographics
NPI:1801210281
Name:PRIDE IN-HOME CARE
Entity type:Organization
Organization Name:PRIDE IN-HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-368-5109
Mailing Address - Street 1:3225 S MACDILL AVE
Mailing Address - Street 2:SUITE 129-183
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8171
Mailing Address - Country:US
Mailing Address - Phone:813-839-3010
Mailing Address - Fax:813-443-2375
Practice Address - Street 1:5007 S ZION ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-3845
Practice Address - Country:US
Practice Address - Phone:813-368-5109
Practice Address - Fax:813-443-2375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-06
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233299305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010407100Medicaid