Healthcare Provider Details

I. General information

NPI: 1154173615
Provider Name (Legal Business Name): SRQ HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2024
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3619 WEBBER ST
SARASOTA FL
34232-4412
US

IV. Provider business mailing address

6124 LUNGO LAGO DR
SARASOTA FL
34241-2723
US

V. Phone/Fax

Practice location:
  • Phone: 941-584-9569
  • Fax:
Mailing address:
  • Phone: 312-545-0806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ITAY SHALEV
Title or Position: PRESIDENT
Credential:
Phone: 312-545-0806