Provider Demographics
NPI:1528693249
Name:WHOLESOME CARE FLORIDA, INC
Entity type:Organization
Organization Name:WHOLESOME CARE FLORIDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEWANU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-523-7711
Mailing Address - Street 1:502 BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:502 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5510
Practice Address - Country:US
Practice Address - Phone:301-523-7711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services