Your Medwaiver Provider Inc

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

YOUR MEDWAIVER PROVIDER INC

Practice address

13200 W Newberry Rd
J50
Newberry, FL 32669-2764

Phone

(352) 474-8492

NPI assigned

Oct 25, 2010

Organization subpart

No

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

Authorized official

Name

Anatoly N Lukyanov

Title

Ceo

Phone

(352) 474-8492

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1287964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1287964800000",
    "number": "1497055487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13200 W NEWBERRY RD",
            "address_2": "J50",
            "city": "NEWBERRY",
            "state": "FL",
            "postal_code": "326692764",
            "telephone_number": "352-474-8492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13200 W NEWBERRY RD",
            "address_2": "J50",
            "city": "NEWBERRY",
            "state": "FL",
            "postal_code": "326692764",
            "telephone_number": "352-474-8492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "YOUR MEDWAIVER PROVIDER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-25",
        "last_updated": "2010-10-25",
        "status": "A",
        "authorized_official_last_name": "LUKYANOV",
        "authorized_official_first_name": "ANATOLY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "352-474-8492"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karianne Wilkins, M.A., CCC-SLP
• Sean Theron Williams, DMD
• Tabitha Wilson, MSW
• Tina Wilson, LMT, CLT
• Alexandra Wooten
• Sarah Jane Zuverino, L.M.T.

• In Home Supportive Care Agency in Newberry, FL
• Providers in Newberry, FL by specialty
• In Home Supportive Care Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2010; 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.