1376685073 NPI number — NEIGHBORLY CARE NETWORK

Table of content: (NPI 1376685073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376685073 NPI number — NEIGHBORLY CARE NETWORK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEIGHBORLY CARE NETWORK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NEIGHBORLY HOME DELIVERED MEALS
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376685073
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13945 EVERGREEN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEARWATER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33762-4525
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-573-9444
Provider Business Mailing Address Fax Number:
727-572-8214

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13945 EVERGREEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEARWATER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33762-4525
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-573-9444
Provider Business Practice Location Address Fax Number:
727-572-8214
Provider Enumeration Date:
02/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LOMAKA
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
727-573-9444

Provider Taxonomy Codes

  • Taxonomy code: 133NN1002X , with the licence number:  N A , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X , with the licence number: 8996 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X , with the licence number: 8944 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QA0600X , with the licence number: 9008 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332U00000X , with the licence number: N A , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 343900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 112687300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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