Healthcare Provider Details

I. General information

NPI: 1881908473
Provider Name (Legal Business Name): CARESOURCE DIRECT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W BAY DR SUITE 409
LARGO FL
33770-3269
US

IV. Provider business mailing address

801 W BAY DR SUITE 409
LARGO FL
33770-3269
US

V. Phone/Fax

Practice location:
  • Phone: 727-688-9074
  • Fax:
Mailing address:
  • Phone: 727-688-9074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PETER IGNACIO
Title or Position: CFO
Credential:
Phone: 727-688-9074