Healthcare Provider Details

I. General information

NPI: 1609685999
Provider Name (Legal Business Name): CAMELLIA PINE HOME CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BEL AIR BLVD STE 140
MOBILE AL
36606-3501
US

IV. Provider business mailing address

600 BEL AIR BLVD STE 140
MOBILE AL
36606-3501
US

V. Phone/Fax

Practice location:
  • Phone: 251-725-0265
  • Fax:
Mailing address:
  • Phone: 251-725-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: SHENITA PORTER
Title or Position: CEO
Credential:
Phone: 346-460-3057