Provider Demographics
NPI:1033723887
Name:MOLLY'S CARE HOME LLC
Entity type:Organization
Organization Name:MOLLY'S CARE HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:IONE ROBYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:GASMENA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:863-899-4094
Mailing Address - Street 1:1616 KENNESAW DR
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6871
Mailing Address - Country:US
Mailing Address - Phone:863-899-4094
Mailing Address - Fax:
Practice Address - Street 1:12195 SE 135TH AVE
Practice Address - Street 2:
Practice Address - City:OCKLAWAHA
Practice Address - State:FL
Practice Address - Zip Code:32179-5203
Practice Address - Country:US
Practice Address - Phone:352-288-0266
Practice Address - Fax:352-288-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility