Healthcare Provider Details

I. General information

NPI: 1073969077
Provider Name (Legal Business Name): GALLEON HOMECARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2016
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552382 US HIGHWAY 1
HILLIARD FL
32046-2328
US

IV. Provider business mailing address

552382 US HIGHWAY 1
HILLIARD FL
32046-2328
US

V. Phone/Fax

Practice location:
  • Phone: 904-675-9230
  • Fax: 904-675-9231
Mailing address:
  • Phone: 904-675-9230
  • Fax: 904-675-9231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: YOLANDA SABRINA KELLAM CARTER
Title or Position: DIRECTOR
Credential:
Phone: 190-489-9233