Healthcare Provider Details

I. General information

NPI: 1649883158
Provider Name (Legal Business Name): LEGACY PREMEIR HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 22ND ST NE
BRADENTON FL
34208-1631
US

IV. Provider business mailing address

581 N PARK AVE UNIT 2472
APOPKA FL
32704-8707
US

V. Phone/Fax

Practice location:
  • Phone: 321-295-1314
  • Fax:
Mailing address:
  • Phone: 321-356-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: ZARETTE MECHELLE PARKER
Title or Position: OWNER
Credential: RN
Phone: 321-295-1314