=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124983549
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NIEVES HOME CARE SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2025
-----------------------------------------------------
Last Update Date | 12/18/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20877 NE PINE ST
-----------------------------------------------------
City | BLOUNTSTOWN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32424-4728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-409-4954
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20877 NE PINE ST
-----------------------------------------------------
City | BLOUNTSTOWN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32424-4728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-409-4954
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AUTHORIZED MEMBER
-----------------------------------------------------
Name | DANA COOPER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 850-409-4954
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------