Organization
BAY AREA DIRECT CLIENT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESHAE MARTIN APRN (ADMINISTRATIVE DIRECTOR)
(813) 679-5122
Entity
Organization
Contact information
Practice address
110 LITHIA PINECREST RD STE B, BRANDON, FL 33511-5300
(813) 679-5122
(564) 524-5855
Mailing address
2105 ROANOKE SPRINGS DR, RUSKIN, FL 33570-6312
(813) 679-5122
(564) 524-5855
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
112087100
—
FL
Enumeration date
09/01/2021
Last updated
01/13/2022
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