Healthcare Provider Details

I. General information

NPI: 1871168047
Provider Name (Legal Business Name): SENIOR CARE OF CLEARWATER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 02/10/2026
Certification Date: 02/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18948 N DALE MABRY HWY STE 102B
LUTZ FL
33548-4917
US

IV. Provider business mailing address

18933 CHAVILLE RD
LUTZ FL
33558-2871
US

V. Phone/Fax

Practice location:
  • Phone: 727-401-4700
  • Fax: 727-498-2046
Mailing address:
  • Phone: 727-401-4700
  • Fax: 727-498-2046

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: ANDREW MALIVUK
Title or Position: OWNER
Credential:
Phone: 727-401-4700