Healthcare Provider Details

I. General information

NPI: 1144560673
Provider Name (Legal Business Name): MELBEACHOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2013
Last Update Date: 06/30/2023
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 S APOLLO BLVD STE 2C
MELBOURNE FL
32901-3183
US

IV. Provider business mailing address

1103 W HIBISCUS BLVD STE 400
MELBOURNE FL
32901-2717
US

V. Phone/Fax

Practice location:
  • Phone: 321-722-2999
  • Fax: 321-586-5372
Mailing address:
  • Phone: 321-722-2999
  • Fax: 321-956-6486

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 Code372600000X
TaxonomyAdult Companion
License Number232571
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number232571
License Number StateFL

VIII. Authorized Official

Name: JENNIFER HELIN
Title or Position: OWNER
Credential:
Phone: 321-722-2999