Healthcare Provider Details

I. General information

NPI: 1134869225
Provider Name (Legal Business Name): EASY LIFE HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 06/04/2022
Certification Date: 06/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 LITTLE JOHN RD
MELBOURNE FL
32935-3736
US

IV. Provider business mailing address

PO BOX 360091
MELBOURNE FL
32936-0091
US

V. Phone/Fax

Practice location:
  • Phone: 321-350-1238
  • Fax: 321-622-8031
Mailing address:
  • Phone: 321-350-1238
  • Fax: 321-622-8031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: NATALIA V BOUSE
Title or Position: OWNER
Credential:
Phone: 321-350-1238