Healthcare Provider Details

I. General information

NPI: 1053010884
Provider Name (Legal Business Name): CARTER'S COMPETENT CARE STAFFING AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 12/11/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

678 SE BAYA DR
LAKE CITY FL
32025-6038
US

IV. Provider business mailing address

219 SE JEREMY PL
LAKE CITY FL
32025-3901
US

V. Phone/Fax

Practice location:
  • Phone: 386-232-8241
  • Fax: 386-381-1099
Mailing address:
  • Phone: 386-232-8241
  • Fax: 386-381-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BLENDA JONES CARTER
Title or Position: OWNER
Credential: RN
Phone: 386-361-2328