Healthcare Provider Details

I. General information

NPI: 1124983549
Provider Name (Legal Business Name): NIEVES HOME CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20877 NE PINE ST
BLOUNTSTOWN FL
32424-4728
US

IV. Provider business mailing address

20877 NE PINE ST
BLOUNTSTOWN FL
32424-4728
US

V. Phone/Fax

Practice location:
  • Phone: 850-409-4954
  • Fax:
Mailing address:
  • Phone: 850-409-4954
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: DANA COOPER
Title or Position: AUTHORIZED MEMBER
Credential:
Phone: 850-409-4954