Healthcare Provider Details

I. General information

NPI: 1760678767
Provider Name (Legal Business Name): HEALTH CARE SERVICES POOL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 N WILLIAMSON BLVD
DAYTONA BEACH FL
32114-7185
US

IV. Provider business mailing address

595 N WILLIAMSON BLVD
DAYTONA BEACH FL
32114-7185
US

V. Phone/Fax

Practice location:
  • Phone: 386-257-4400
  • Fax: 386-257-4372
Mailing address:
  • Phone: 386-257-4400
  • Fax: 386-257-4372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. RANDOLPH L KERNON II
Title or Position: VICE PRESIDENT
Credential: LNHA
Phone: 386-257-4400