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General NPI Number Information
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NPI Number | 1033582333
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Entity Type | Organization
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Legal Business Name | MLS HOMEMAKER/COMPANION SERVICE
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Dates
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Enumeration Date | 11/09/2015
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Last Update Date | 11/09/2015
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Provider Practice Location Address
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Address Line | 1406 COUNTY ROAD 228
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City | WILDWOOD
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State | FL
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Zip | 34785
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Country | US
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Telephone | 352-571-0492
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Fax |
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Provider Business Mailing Address
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Address Line | 1406 COUNTY ROAD 228
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City | WILDWOOD
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State | FL
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Zip | 34785-8507
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Country | US
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Telephone | 352-571-0492
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MAGNOLIA SOLOMON
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Credential |
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Telephone | 352-603-0126
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 233935
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License Number State | FL
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