Provider Demographics
NPI:1881019578
Name:A.I.D.3
Entity type:Organization
Organization Name:A.I.D.3
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:FENNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BACCHUS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:321-441-3695
Mailing Address - Street 1:2443 LEE RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1755
Mailing Address - Country:US
Mailing Address - Phone:321-441-3695
Mailing Address - Fax:407-960-3946
Practice Address - Street 1:2443 LEE RD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-1755
Practice Address - Country:US
Practice Address - Phone:321-441-3695
Practice Address - Fax:407-960-3946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4326251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care