Provider Demographics
NPI:1730995879
Name:JOSEPH, MONTCARMELLE
Entity type:Individual
Prefix:
First Name:MONTCARMELLE
Middle Name:
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1016 GOLDEN SHINER AVE
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-3310
Mailing Address - Country:US
Mailing Address - Phone:195-429-7761
Mailing Address - Fax:
Practice Address - Street 1:1016 GOLDEN SHINER AVE
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-3310
Practice Address - Country:US
Practice Address - Phone:195-429-7761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home