Healthcare Provider Details

I. General information

NPI: 1417525312
Provider Name (Legal Business Name): MS PHYLLIS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 07/24/2023
Certification Date: 07/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16903 LAKESIDE DR STE 4
MONTVERDE FL
34756-3230
US

IV. Provider business mailing address

1121 STRATTON AVE
GROVELAND FL
34736-8203
US

V. Phone/Fax

Practice location:
  • Phone: 321-209-1322
  • Fax: 407-386-7774
Mailing address:
  • Phone: 321-209-1322
  • Fax: 407-386-7774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. PHYLLIS ALFRED
Title or Position: OWNER/MANAGER
Credential:
Phone: 352-321-2727