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General NPI Number Information
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NPI Number | 1063716975
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Entity Type | Organization
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Legal Business Name | HOME COMPANIONS OF LAKE CO., INC
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Dates
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Enumeration Date | 01/06/2011
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Last Update Date | 01/06/2011
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Provider Practice Location Address
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Address Line | 2785 S BAY ST STE D
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City | EUSTIS
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State | FL
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Zip | 32726-6591
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Country | US
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Telephone | 352-483-3086
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Fax | 352-483-3136
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Provider Business Mailing Address
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Address Line | PO BOX 148
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City | TAVARES
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State | FL
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Zip | 32778-0148
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Country | US
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Telephone | 352-483-3086
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Fax | 352-483-3136
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Authorized Official
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Title or Position | ACCOUNTS MANAGER
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Name | MS. AVIE LEE KEITH
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Credential |
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Telephone | 352-483-3086
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 299992225
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License Number State | FL
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