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General NPI Number Information
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NPI Number | 1144678749
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Entity Type | Organization
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Legal Business Name | BIDWELL HOME CARE SERVICE LLC
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Dates
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Enumeration Date | 05/25/2016
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Last Update Date | 05/25/2016
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Provider Practice Location Address
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Address Line | 520 E OLYMPIA AVE
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City | PUNTA GORDA
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State | FL
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Zip | 33950-3838
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Country | US
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Telephone | 941-505-0450
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Fax |
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Provider Business Mailing Address
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Address Line | 520 E OLYMPIA AVE
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City | PUNTA GORDA
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State | FL
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Zip | 33950-3838
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LAURA BETH GILLIAN
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Credential |
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Telephone | 941-505-0450
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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 | 299994400
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License Number State | FL
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