Wisteria Elderly Care, LLC

Primary specialty

Respite CareTaxonomy code 385H00000X

License

6906533 Issued in FL

Legal business name

WISTERIA ELDERLY CARE, LLC

Practice address

189 Donald Ave NE
Palm Bay, FL 32907-3158

Phone

(321) 345-4177

Fax

(321) 345-4177

NPI assigned

Mar 29, 2013

Last updated

Mar 29, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Witza Larionne

Title

Owner

Phone

(321) 345-4177

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1364515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364515200000",
    "number": "1154664043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 DONALD AVE NE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329073158",
            "telephone_number": "321-345-4177",
            "fax_number": "321-345-4177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 DONALD AVE NE",
            "city": "PALM BAY",
            "state": "FL",
            "postal_code": "329073158",
            "telephone_number": "321-345-4177",
            "fax_number": "321-345-4177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISTERIA ELDERLY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-29",
        "last_updated": "2013-03-29",
        "status": "A",
        "authorized_official_last_name": "LARIONNE",
        "authorized_official_first_name": "WITZA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-345-4177",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "347C00000X",
            "taxonomy_group": "",
            "desc": "Private Vehicle",
            "state": "FL",
            "license": "232475",
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": "FL",
            "license": "6906533",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Respite Care in Palm Bay, FL
• Providers in Palm Bay, FL by specialty
• Respite Care in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2013; 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.