Healthcare Provider Details

I. General information

NPI: 1104085307
Provider Name (Legal Business Name): CROWN SENIOR SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 CANARY ISLAND CIR
DAVENPORT FL
33837-5553
US

IV. Provider business mailing address

418 CANARY ISLAND CIR
DAVENPORT FL
33837-5553
US

V. Phone/Fax

Practice location:
  • Phone: 863-424-6306
  • Fax:
Mailing address:
  • Phone: 863-424-6306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number230388
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number230388
License Number StateFL

VIII. Authorized Official

Name: JUDITH RENE FIGAREAU
Title or Position: OWNER
Credential:
Phone: 863-424-6306