Healthcare Provider Details

I. General information

NPI: 1124544366
Provider Name (Legal Business Name): EMPATHETIC HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2017
Last Update Date: 08/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 SAINT GEORGES RD APT 208
ORMOND BEACH FL
32174-1125
US

IV. Provider business mailing address

9000 SAINT GEORGES RD APT 208
ORMOND BEACH FL
32174-1125
US

V. Phone/Fax

Practice location:
  • Phone: 386-675-7233
  • Fax:
Mailing address:
  • Phone: 386-675-7233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9437173
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number947173
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number9437173
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number9437173
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number9437173
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number9437173
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number9437173
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number943173
License Number StateFL
# 9
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number947173
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number943173
License Number StateFL
# 11
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number947173
License Number StateFL
# 12
Primary TaxonomyN
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 13
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number9437173
License Number StateFL
# 14
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number9437173
License Number StateFL

VIII. Authorized Official

Name: KRISTY BROWN
Title or Position: REGISTERED NURSE
Credential: R.N.
Phone: 386-675-7233