Healthcare Provider Details

I. General information

NPI: 1992012942
Provider Name (Legal Business Name): CARE-AT-HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 ULMERTON RD #926
LARGO FL
33771-0000
US

IV. Provider business mailing address

PO BOX 358292
GAINESVILLE FL
32635-8292
US

V. Phone/Fax

Practice location:
  • Phone: 352-222-8968
  • Fax: 352-332-7187
Mailing address:
  • Phone: 352-222-8968
  • Fax: 352-332-7187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. INNA ANATOLY LUKYANOV
Title or Position: AS PRESIDENT FOR CARE-AT-HOME INC
Credential:
Phone: 352-222-8968