Provider Demographics
NPI:1215330295
Name:COLEMAN ADULT FAMILY CARE HOME
Entity type:Organization
Organization Name:COLEMAN ADULT FAMILY CARE HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DOTLYN
Authorized Official - Middle Name:SALOME
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:321-303-4907
Mailing Address - Street 1:3410 WESTFORD DR
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32712-5647
Mailing Address - Country:US
Mailing Address - Phone:321-303-4907
Mailing Address - Fax:407-523-3798
Practice Address - Street 1:3410 WESTFORD DR
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32712-5647
Practice Address - Country:US
Practice Address - Phone:321-303-4907
Practice Address - Fax:407-523-3798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-03
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906682311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL142490400Medicaid