Provider Demographics
NPI:1932807369
Name:CAROLCO ENTERPRISES INC.
Entity type:Organization
Organization Name:CAROLCO ENTERPRISES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN L DELOACH
Authorized Official - Middle Name:L
Authorized Official - Last Name:DELOACH
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:941-586-3734
Mailing Address - Street 1:6104 VIVIENDA DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34207-4359
Mailing Address - Country:US
Mailing Address - Phone:941-586-3734
Mailing Address - Fax:
Practice Address - Street 1:6104 VIVIENDA DR
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4359
Practice Address - Country:US
Practice Address - Phone:941-586-3734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-15
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL237317OtherCNA