Provider Demographics
NPI:1871924225
Name:JUANITO GASPAR
Entity type:Organization
Organization Name:JUANITO GASPAR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JUANITO
Authorized Official - Middle Name:
Authorized Official - Last Name:GASPAR
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:727-441-2942
Mailing Address - Street 1:1224 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-4255
Mailing Address - Country:US
Mailing Address - Phone:727-441-2942
Mailing Address - Fax:
Practice Address - Street 1:1224 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-4255
Practice Address - Country:US
Practice Address - Phone:727-441-2942
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6906642261QA0600X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6906642OtherAHCA-ADULT FAMILY CARE HOME