Adult Family Care Home

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

6906614 Issued in FL

Legal business name

ADULT FAMILY CARE HOME

Practice address

309 N Wetmore St
Lake Wales, FL 33853-4057

Phone

(863) 223-8104

NPI assigned

Aug 21, 2014

Last updated

Aug 27, 2014By 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

Rhonda Richardson

Title

Owner/Adm

Phone

(863) 223-8104

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1408579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1409097600000",
    "number": "1669871083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "309 N WETMORE ST",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534057",
            "telephone_number": "863-223-8104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "309 N WETMORE ST",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534057",
            "telephone_number": "863-223-8104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADULT FAMILY CARE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-08-21",
        "last_updated": "2014-08-27",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "RHONDA",
        "authorized_official_title_or_position": "OWNER/ADM",
        "authorized_official_telephone_number": "863-223-8104"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "FL",
            "license": "6906614",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008834600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Lake Wales, FL
• Providers in Lake Wales, 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 Aug 27, 2014; 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.