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General NPI Number Information
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NPI Number | 1033976964
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Entity Type | Organization
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Legal Business Name | BEDROCK AT HOME ORLANDO, LLC
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Dates
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Enumeration Date | 03/06/2024
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Last Update Date | 03/19/2024
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Provider Practice Location Address
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Address Line | 3800 TOWN CTR BLVD
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City | ORLANDO
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State | FL
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Zip | 32837-6196
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Country | US
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Telephone | 407-505-4602
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Fax | 407-505-4603
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Provider Business Mailing Address
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Address Line | 3800 TOWN CTR BLVD
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City | ORLANDO
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State | FL
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Zip | 32837-6196
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Country | US
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Telephone | 407-505-4602
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Fax | 407-505-4603
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Authorized Official
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Title or Position | BUSINESS OPERATIONS MANAGER
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Name | BAILEY KLEINKNECHT
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Credential |
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Telephone | 407-505-4602
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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 |
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License Number State |
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