Healthcare Provider Details

I. General information

NPI: 1447611801
Provider Name (Legal Business Name): FLAGLER BEACH HOMECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2016
Last Update Date: 03/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S CENTRAL AVE
FLAGLER BEACH FL
32136-3721
US

IV. Provider business mailing address

1222 S CENTRAL AVE
FLAGLER BEACH FL
32136-3721
US

V. Phone/Fax

Practice location:
  • Phone: 386-338-2072
  • Fax:
Mailing address:
  • Phone: 386-338-2072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberPN5181900
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberPN5181900
License Number StateFL

VIII. Authorized Official

Name: GENA S SNEAD
Title or Position: PRESIDENT
Credential: NURSE
Phone: 386-338-2072