Healthcare Provider Details

I. General information

NPI: 1689114019
Provider Name (Legal Business Name): ONE FAMILY HOME HEALTH CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2017
Last Update Date: 03/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BURNING WICK PL
PALM COAST FL
32137-8802
US

IV. Provider business mailing address

19 BURNING WICK PL
PALM COAST FL
32137-8802
US

V. Phone/Fax

Practice location:
  • Phone: 386-631-0432
  • Fax: 386-597-2779
Mailing address:
  • Phone: 386-631-0432
  • Fax: 386-597-2779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number6906826
License Number StateFL

VIII. Authorized Official

Name: MARIE ERLYNE LOUIS
Title or Position: ADMINISTRATOR
Credential:
Phone: 386-631-0432