Healthcare Provider Details

I. General information

NPI: 1831883545
Provider Name (Legal Business Name): AMERIVITA HOME CARE WEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W MAIN ST
BARTOW FL
33830-3657
US

IV. Provider business mailing address

1553 BOREN DR
OCOEE FL
34761-2989
US

V. Phone/Fax

Practice location:
  • Phone: 321-281-3038
  • Fax: 321-284-4933
Mailing address:
  • Phone: 321-281-3038
  • Fax: 321-284-4933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NICOLE JOSEPH
Title or Position: PRESIDENT/ADMIN/CFO
Credential:
Phone: 407-462-7670