Healthcare Provider Details

I. General information

NPI: 1336817667
Provider Name (Legal Business Name): ATTENTIVE IN HOME CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 02/03/2022
Certification Date: 09/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

890 INDEPENDENT ST
MONTICELLO FL
32344-1510
US

IV. Provider business mailing address

890 INDEPENDENT ST
MONTICELLO FL
32344-1510
US

V. Phone/Fax

Practice location:
  • Phone: 850-879-2084
  • Fax:
Mailing address:
  • Phone: 850-901-7070
  • Fax:

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 Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MATTIE NEALY NEALY
Title or Position: OWNER
Credential:
Phone: 850-901-7070