Healthcare Provider Details

I. General information

NPI: 1649906330
Provider Name (Legal Business Name): FLORIDA COMMUNITY HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2022
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 MCCOY DR
LAKE PLACID FL
33852-9552
US

IV. Provider business mailing address

414 DERBY WAY
WILMINGTON DE
19810-2266
US

V. Phone/Fax

Practice location:
  • Phone: 267-262-3929
  • Fax:
Mailing address:
  • Phone: 267-262-3929
  • Fax:

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: MONIDA VANTHA
Title or Position: VP
Credential:
Phone: 267-262-3929