Healthcare Provider Details

I. General information

NPI: 1598651010
Provider Name (Legal Business Name): FIVE STAR PROFESSIONAL HOME CARE STAFFING 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2846 RECKER HWY
WINTER HAVEN FL
33880-1941
US

IV. Provider business mailing address

4131 UNIVERSITY BLVD S STE 12
JACKSONVILLE FL
32216-4352
US

V. Phone/Fax

Practice location:
  • Phone: 904-673-8416
  • Fax:
Mailing address:
  • Phone: 904-673-8416
  • Fax: 904-661-1916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MELONIE MILLER
Title or Position: OWNER
Credential:
Phone: 904-673-8416