Provider Demographics
NPI:1861880973
Name:DAVIDS HOLISTIC CARE CENTER INC.
Entity type:Organization
Organization Name:DAVIDS HOLISTIC CARE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-990-6333
Mailing Address - Street 1:4623 EBONY ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-3823
Mailing Address - Country:US
Mailing Address - Phone:407-990-6333
Mailing Address - Fax:321-206-4502
Practice Address - Street 1:4623 EBONY ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-3823
Practice Address - Country:US
Practice Address - Phone:407-990-6333
Practice Address - Fax:321-206-4502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-26
Last Update Date:2015-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007902900Medicaid
FL232909Medicaid
FL007902901Medicaid