Shirley Adams
Individual provider Active NPI Assisted Living Facility · Welaka, FL
NPI 1285970632 · NPPES record last updated Dec 12, 2012
Key facts
- NPI
- 1285970632
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- AL5705 (FL)
- Practice address
- 611 Old Welaka Rd
Welaka, FL 32193-2172 - Phone
- (386) 467-2004
- Fax
- (386) 467-9998
- NPI assigned
- Dec 12, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL5705 | FL | MD | Assisted Living Facility |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shirley Adams Dba Five Oaks Rest Home | Assisted Living Facility | Current |
Accepting new patients |
| Samuel R Galitzer DPM PA | Past | Accepting new patients |
Locations
611 Old Welaka Rd
Welaka, FL 32193
Phone (386) 467-2004
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | AL5705 | FL | Yes |
Addresses
Primary practice location
611 Old Welaka Rd
Welaka, FL 32193-2172
Mailing address
611 Old Welaka Rd
Welaka, FL 32193-2172
Phone (386) 467-2004
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 686143100 | Medicaid | FL | |
| 140334600 | Medicaid | FL |
Other providers in Welaka, FL
All providers in Welaka, FL · Assisted Living Facility in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 12, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.