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General NPI Number Information
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NPI Number | 1134550387
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Entity Type | Organization
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Legal Business Name | SENIOR MOMENTS HOME HEALTH, INC.
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Dates
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Enumeration Date | 12/12/2013
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Last Update Date | 12/12/2013
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Provider Practice Location Address
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Address Line | 216 N 3RD ST STE A
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City | LEESBURG
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State | FL
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Zip | 34748-5197
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Country | US
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Telephone | 352-323-6100
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Fax | 352-323-6130
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Provider Business Mailing Address
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Address Line | 216 N 3RD ST STE A
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City | LEESBURG
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State | FL
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Zip | 34748-5197
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Country | US
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Telephone | 352-323-6100
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Fax | 352-323-6130
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Authorized Official
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Title or Position | CFO/VP
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Name | MR. MATTHEW J GRAVAT
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Credential |
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Telephone | 352-323-6100
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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 | HHA 299993225
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License Number State | FL
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