Elianne D. Jerome

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

6905950 Issued in FL

Legal business name

ELIANNE D. JEROME

Practice address

2158 Brandon Park Cir
Brandon, FL 33510-3946

Phone

(813) 654-6886

Fax

(813) 654-6886

NPI assigned

May 2, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Elianne D. Jerome, HHA

Title

Owner

Phone

(813) 654-6886

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1304294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1304294400000",
    "number": "1003107533",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2158 BRANDON PARK CIR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335103946",
            "telephone_number": "813-654-6886",
            "fax_number": "813-654-6886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2158 BRANDON PARK CIR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335103946",
            "telephone_number": "813-654-6886",
            "fax_number": "813-654-6886"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELIANNE D. JEROME",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-02",
        "last_updated": "2011-05-02",
        "status": "A",
        "authorized_official_last_name": "JEROME",
        "authorized_official_first_name": "ELIANNE",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-654-6886",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "HHA"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "FL",
            "license": "6905950",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "142556100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Brandon, FL
• Providers in Brandon, FL by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.