Healthcare Provider Details

I. General information

NPI: 1235236449
Provider Name (Legal Business Name): CARETENDERS VISITING SERVICES OF ST. AUGUSTINE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 05/26/2020
Certification Date: 05/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 US HIGHWAY 1 S STE 403
ST AUGUSTINE FL
32086-6363
US

IV. Provider business mailing address

901 HUGH WALLIS RD S
LAFAYETTE LA
70508-2511
US

V. Phone/Fax

Practice location:
  • Phone: 904-810-5474
  • Fax: 904-826-0224
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-443-4154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. NICHOLAS GACHASSIN III
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 337-233-1307