Healthcare Provider Details

I. General information

NPI: 1194292052
Provider Name (Legal Business Name): IN HOME CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 01/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 WESTERN AVE
EAST MILLINOCKET ME
04430-1040
US

IV. Provider business mailing address

499 53RD AVE N
ST PETERSBURG FL
33703-2960
US

V. Phone/Fax

Practice location:
  • Phone: 727-249-3307
  • Fax:
Mailing address:
  • Phone: 727-249-3307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: MR. MATHEW SHANKWEILER
Title or Position: PRESIDENT
Credential:
Phone: 727-249-3307