Eddison Nelson

Primary specialty

Adult Care Home FacilityTaxonomy code 311ZA0620X

License

6906576 Issued in FL

Legal business name

EDDISON NELSON

Practice address

1292 Dorchester St
Port Charlotte, FL 33952-2512

Phone

(727) 623-2267

NPI assigned

May 22, 2013

Last updated

May 22, 2013By 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

Eddison Nelson

Title

Owner

Phone

(727) 623-2267

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1369180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369180800000",
    "number": "1881031417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1292 DORCHESTER ST",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339522512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1292 DORCHESTER ST",
            "city": "PORT CHARLOTTE",
            "state": "FL",
            "postal_code": "339522512",
            "telephone_number": "727-623-2267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDDISON NELSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-22",
        "last_updated": "2013-05-22",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "EDDISON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "727-623-2267"
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "FL",
            "license": "6906576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Adult Care Home Facility in Port Charlotte, FL
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2013; 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.