Robert Vereen Adult Family Care Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

6905877 Issued in FL

Legal business name

ROBERT VEREEN ADULT FAMILY CARE HOME

Practice address

10010 Benjamin Smith Dr
Thonotosassa, FL 33592-3367

Phone

(813) 986-9003

NPI assigned

Jan 24, 2015

Organization subpart

No

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

Authorized official

Name

Mary Dean Pearson-Vereen

Title

Administrator

Phone

(813) 986-9003

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robert Ponder Vereen

  • Adult Care Home Facility
  • Thonotosassa, FL
  • NPI 1174010755
  NPD (past)

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

{
    "created_epoch": "1422057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1422057600000",
    "number": "1326438748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10010 BENJAMIN SMITH DR",
            "city": "THONOTOSASSA",
            "state": "FL",
            "postal_code": "335923367"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10010 BENJAMIN SMITH DR",
            "city": "THONOTOSASSA",
            "state": "FL",
            "postal_code": "335923367",
            "telephone_number": "813-986-9003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT VEREEN ADULT FAMILY CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-01-24",
        "last_updated": "2015-01-24",
        "status": "A",
        "authorized_official_last_name": "PEARSON-VEREEN",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "813-986-9003"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "FL",
            "license": "6905877",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "141386400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Thonotosassa, FL
• Providers in Thonotosassa, FL by specialty
• Adult Care Home Facility in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2015; 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.