| Organization Name: | BREAKWATER ADULT FAMILY CARE HOME, LLC |
| NPI Number: | 1396712477 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VINCE L JACOBS (OWNER-PROVIDER) |
| Mailing Address: | 22699 Sw Breakwater Blvd Dunnellon |
| State: | FL US |
| Postal Code: | 344314039 |
| Phone Number: | 3524654877 |
| Fax Number: | 3524658033 |
| NPI Enumeration Date: | 03/07/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 251C00000X |
| License Number: | 6905655 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Agencies |
| Taxonomy Classification: | Day Training, Developmentally Disabled Services |
| Taxonomy Specialization: | |
| Taxonomy Definition: | These agencies are authorized to provide day habilitation services to developmentally disabled individuals who live in their homes. The function of day habilitation is to assist an individual to acquire and maintain those life skills that enable the individual to cope more effectively with the demands of independent living. Also to raise the level of the individual's physical, mental, social, and vocational functioning. |