Healthcare Provider Details

I. General information

NPI: 1831526946
Provider Name (Legal Business Name): CENTRAL PINELLAS CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 HEATHER RIDGE BLVD
DUNEDIN FL
34698-5620
US

IV. Provider business mailing address

1310 HEATHER RIDGE BLVD
DUNEDIN FL
34698-5620
US

V. Phone/Fax

Practice location:
  • Phone: 727-437-4170
  • Fax: 727-674-1540
Mailing address:
  • Phone: 727-437-4170
  • Fax: 727-674-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299994053
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number232362
License Number StateFL

VIII. Authorized Official

Name: MS. CATHERINE GOOCHER
Title or Position: CEO/OWNER
Credential: RN
Phone: 727-437-4170