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General NPI Number Information
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NPI Number | 1174160493
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Entity Type | Organization
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Legal Business Name | FULLY ALIVE HOMECARE LLC
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 12/05/2019
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Provider Practice Location Address
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Address Line | 1780 STANDING ROCK CIR
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City | WINTER GARDEN
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State | FL
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Zip | 34787-8116
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Country | US
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Telephone | 407-960-0672
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Fax |
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Provider Business Mailing Address
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Address Line | 1780 STANDING ROCK CIR
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City | WINTER GARDEN
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State | FL
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Zip | 34787-8116
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Country | US
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Telephone | 407-960-0672
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Fax |
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Authorized Official
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Title or Position | DON/ ADMINISTRATOR
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Name | MRS. SUSAN MELISA VASQUEZ
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Credential | RN BSN
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Telephone | 407-978-9826
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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 |
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License Number State |
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