Healthcare Provider Details

I. General information

NPI: 1720671530
Provider Name (Legal Business Name): HIGHLANDS ELDER CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 CUMQUAT RD NE
LAKE PLACID FL
33852-5951
US

IV. Provider business mailing address

230 CUMQUAT RD NE
LAKE PLACID FL
33852-5951
US

V. Phone/Fax

Practice location:
  • Phone: 863-633-0777
  • Fax: 877-724-0191
Mailing address:
  • Phone: 863-633-0777
  • Fax:

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: ROBIN KELLY TESSMAN
Title or Position: PRESIDENT
Credential:
Phone: 863-633-0777