Provider Demographics
NPI:1962994582
Name:ROSS DYNASTY CARES
Entity type:Organization
Organization Name:ROSS DYNASTY CARES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:RAYNETTE
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-674-1771
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33975-0621
Mailing Address - Country:US
Mailing Address - Phone:863-674-1771
Mailing Address - Fax:
Practice Address - Street 1:462 E COWBOY WAY STE 1
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4445
Practice Address - Country:US
Practice Address - Phone:863-674-1771
Practice Address - Fax:863-674-1771
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSS DYNASTY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-05-30
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11596101YP2500X
251E00000X, 251G00000X, 253Z00000X, 261QD1600X, 385H00000X, 385HR2060X, 385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, ChildGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107840700Medicaid
FL107272300Medicaid
FL0234408300Medicaid