Basic Information
| Provider Information | |||||||||
| NPI: | 1205230174 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARETENDERS VISITING SERVICES OF GAINESVILLE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CARETENDERS HEALTH AND REHAB | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8109 NW 27TH BLVD | ||||||||
| Address2: | CARETENDERS HEALTH AND REHAB | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326068636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527926464 | ||||||||
| FaxNumber: | 3527926463 | ||||||||
| Practice Location | |||||||||
| Address1: | 8109 NW 27TH BLVD | ||||||||
| Address2: | CARETENDERS HEALTH AND REHAB | ||||||||
| City: | GAINESVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 326068636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527926464 | ||||||||
| FaxNumber: | 3527926463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/21/2014 | ||||||||
| LastUpdateDate: | 10/21/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BOTES | ||||||||
| AuthorizedOfficialFirstName: | SIRA | ||||||||
| AuthorizedOfficialMiddleName: | NEL | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 3523590739 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OTR/L CHT | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | HCC10217 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.