Healthcare Provider Details

I. General information

NPI: 1972870442
Provider Name (Legal Business Name): SPIRIT HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 05/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 E OLYMPIA AVE UNIT 244
PUNTA GORDA FL
33950-3823
US

IV. Provider business mailing address

315 E OLYMPIA AVE SUITE 244
PUNTA GORDA FL
33950-3823
US

V. Phone/Fax

Practice location:
  • Phone: 941-505-1594
  • Fax: 941-505-1599
Mailing address:
  • Phone: 941-505-1594
  • Fax: 941-505-1599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number30211522
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number30211522
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number30211522
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number30211522
License Number StateFL

VIII. Authorized Official

Name: MS. NILSA BAPTISTE
Title or Position: ADMINISTRATOR
Credential:
Phone: 941-505-1594