Basic Information
| Provider Information | |||||||||
| NPI: | 1902159320 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DIANNE CLAY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7441 CLARCONA OCOEE RD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328181211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073942397 | ||||||||
| FaxNumber: | 4072909509 | ||||||||
| Practice Location | |||||||||
| Address1: | 7441 CLARCONA OCOEE RD | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328181211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073942397 | ||||||||
| FaxNumber: | 4072909509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2012 | ||||||||
| LastUpdateDate: | 10/23/2012 | ||||||||
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| AuthorizedOfficialLastName: | CLAY | ||||||||
| AuthorizedOfficialFirstName: | DIANNE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | HOME HEALTH/ MEDICAL ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 4073942397 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
No ID Information.