Healthcare Provider Details

I. General information

NPI: 1740372275
Provider Name (Legal Business Name): CLASSIC HOME HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2294 COUNTY ROAD 526 E
SUMTERVILLE FL
33585-5178
US

IV. Provider business mailing address

PO BOX 400
SUMTERVILLE FL
33585-0400
US

V. Phone/Fax

Practice location:
  • Phone: 352-568-8200
  • Fax: 352-568-8202
Mailing address:
  • Phone: 352-568-8200
  • Fax: 352-568-8202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. NANCY GRAVES-THOMAS
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 352-568-8200