Taxonomy Codes
The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:
| No. |
Taxonomy Code |
Taxonomy Clasification |
Taxonomy Specialization |
License Number |
License State |
Primary |
| 1 | 251B00000X | Case Management | | | | No |
| 2 | 251E00000X | Home Health | | | | No |
| 3 | 251J00000X | Nursing Care | | | | No |
| 4 | 251S00000X | Community/Behavioral Health | | | | No |
| 5 | 253Z00000X | In Home Supportive Care | | | | No |
| 6 | 261QA0600X | Clinic/Center | Adult Day Care | | | No |
| 7 | 261QM0801X | Clinic/Center | Mental Health (Including Community Mental Health Center) | | | No |
| 8 | 261QM0850X | Clinic/Center | Adult Mental Health | | | No |
| 9 | 310400000X | Assisted Living Facility | | | | No |
| 10 | 311500000X | Alzheimer Center (Dementia Center) | | | | No |
| 11 | 314000000X | Skilled Nursing Facility | | | | No |
| 12 | 385H00000X | Respite Care | | | | No |
| 13 | 313M00000X | Nursing Facility/Intermediate Care Facility | | | | Yes |
Other Identifiers
The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.
| No. |
Other Provider Identifier |
Other Provider Identifier Type |
Other Provider Identifier State |
Other Provider Identifier Issuer |
| 1 | 96EQ6 | OTHER | | SAM CAGE CODE |
| 2 | 100011400 | MEDICAID | FLORIDA | |
| 3 | GJHJCRUH32H5 | OTHER | | SAM UNIQUE ENTITY ID |
| 4 | 11968599 | OTHER | FLORIDA | AGENCY FOR HEALTHCARE ADMINISTRATION (AHCA) |
