Healthcare Provider Details

I. General information

NPI: 1609782242
Provider Name (Legal Business Name): AMI HOME HEALTH,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4477 BIG TANK RD
LAKE WALES FL
33898-7128
US

IV. Provider business mailing address

4477 BIG TANK RD
LAKE WALES FL
33898-7128
US

V. Phone/Fax

Practice location:
  • Phone: 321-689-5493
  • Fax:
Mailing address:
  • Phone: 321-689-5493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARIE-LOURDES ISNARD ACHILLE
Title or Position: ADMINISTRATOR
Credential:
Phone: 321-460-3262