Healthcare Provider Details

I. General information

NPI: 1780406462
Provider Name (Legal Business Name): AT HOME KIDS CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 GRAND CANAL DR
POINCIANA FL
34759-4361
US

IV. Provider business mailing address

PO BOX 580421
KISSIMMEE FL
34758-0006
US

V. Phone/Fax

Practice location:
  • Phone: 689-238-6315
  • Fax:
Mailing address:
  • Phone: 689-238-6315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. BRIANA BROWN
Title or Position: OWNER/ PROVIDER
Credential:
Phone: 689-238-6315