Organization
BAY AREA DIRECT CLIENT CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DESHAE MARTIN NURSE PRACTITIONER (ADMINISTRATIVE DIRECTOR)
(813) 585-7708
Entity
Organization
Contact information
Practice address
110 LITHIA PINECREST RD STE B, BRANDON, FL 33511-5300
(813) 679-5122
Mailing address
2105 ROANOKE SPRINGS DR, RUSKIN, FL 33570-6312
Taxonomy
Speciality
Code
Description
License number
State
207RI0001X
Clinical & Laboratory Immunology (Internal Medicine) Physician
Primary
—
—
251E00000X
Home Health Agency
—
—
251J00000X
Nursing Care Agency
—
—
313M00000X
Nursing Facility/Intermediate Care Facility
—
—
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
—
—
373H00000X
Day Training/Habilitation Specialist
—
FL
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
025147900
—
FL
01
—
NONE
NONE ASSOCIATED
FL
Enumeration date
06/18/2018
Last updated
06/11/2021
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