Healthcare Provider Details

I. General information

NPI: 1861128860
Provider Name (Legal Business Name): AMERICANS DREAM HOME CARE AGENCY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 08/01/2022
Certification Date: 08/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3049 CLEVELAND AVE STE 243
FORT MYERS FL
33901-7046
US

IV. Provider business mailing address

12888 PASTURES WAY
FORT MYERS FL
33913-7634
US

V. Phone/Fax

Practice location:
  • Phone: 239-324-6799
  • Fax: 239-324-6799
Mailing address:
  • Phone: 239-324-6799
  • Fax: 239-324-6799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: ROSETTE DIE SAINT JOUR
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 239-324-6799