Florida Homestyle Manor, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

FLORIDA HOMESTYLE MANOR, LLC

Practice address

481 Dagama Dr
Clermont, FL 34715-8037

Phone

(205) 541-9580

NPI assigned

Jun 30, 2020

Last updated

Aug 22, 2021By 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

Anthony C Grove

Title

Chief Executive Officer

Phone

(205) 541-9580

Specialties & licenses 3

Addresses

Other identifiers 2

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

{
    "created_epoch": "1593475200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1629590400000",
    "number": "1568089050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 SADIE RIDGE RD",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347150069",
            "telephone_number": "205-541-9580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "481 DAGAMA DR",
            "city": "CLERMONT",
            "state": "FL",
            "postal_code": "347158037",
            "telephone_number": "205-541-9580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA HOMESTYLE MANOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-30",
        "last_updated": "2021-08-22",
        "certification_date": "2021-08-22",
        "status": "A",
        "authorized_official_last_name": "GROVE",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "205-541-9580"
    },
    "taxonomies": [
        {
            "code": "251C00000X",
            "taxonomy_group": "",
            "desc": "Day Training, Developmentally Disabled Services",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109504600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AGENCY FOR PERSONS WITH DISABILITIES - APD",
            "identifier": "13002507",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Florida Cardiovascular Specialists, PA
• Florida ENT Associates, Inc.
• Florida Eye Clinic P a
• Florida Family Physicians
• Florida Hills Care Inc
• Florida Institute of Research, Medicine, and Surgery, P.a. (Cancer Centers of Florida)
• Florida Orthopedic and Rehab LLC (Florida Sports Injury and Orthopedic Institute)
• Florida Pain Care PLLC
• Florida Radiology Imaging at Lake Mary, LLC (AdventHealth Imaging Center Clermont)
• Florida Speech & Language LLC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2021; 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.