Healthcare Provider Details

I. General information

NPI: 1730762287
Provider Name (Legal Business Name): OLYMPIA HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 11/24/2021
Certification Date: 11/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 SOUTHGATE CIR STE 132
SARASOTA FL
34239-5514
US

IV. Provider business mailing address

3230 SOUTHGATE CIR STE 132
SARASOTA FL
34239-5514
US

V. Phone/Fax

Practice location:
  • Phone: 646-240-7236
  • Fax:
Mailing address:
  • Phone: 646-240-7236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: ANJEZA MANKO
Title or Position: OWNER/ PRESIDENT
Credential:
Phone: 646-240-7236