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Organization
MY PLACE LLC
Active
Organization
MY PLACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LA'STACIA BUSH RN (AUTHORIZED OFFICIAL)
(386) 983-0154
Entity
Organization
Contact information
Practice address
713 DOBY AVE, ORLANDO, FL 32805-3046
(386) 983-0154
Mailing address
801 PECORI TER, OCOEE, FL 34761-5028
(386) 983-0154
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
251J00000X
Nursing Care Agency
—
—
251S00000X
Community/Behavioral Health Agency
—
—
253J00000X
Foster Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
—
—
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
314000000X
Skilled Nursing Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
385H00000X
Respite Care
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0135291002
—
FL
Enumeration date
02/20/2019
Last updated
02/20/2019
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