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General NPI Number Information
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NPI Number | 1184922668
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Entity Type | Organization
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Legal Business Name | ISLAND HOME CARE AGENCY, INC
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Dates
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Enumeration Date | 03/07/2011
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Last Update Date | 08/13/2013
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Provider Practice Location Address
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Address Line | 817 SIMONTON ST
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City | KEY WEST
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State | FL
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Zip | 33040-7445
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Country | US
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Telephone | 305-735-4460
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Fax | 305-453-6186
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Provider Business Mailing Address
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Address Line | 1200 4TH ST SUITE 179
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City | KEY WEST
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State | FL
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Zip | 33040-3763
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Country | US
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Telephone | 305-735-4460
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Fax | 305-453-6186
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. KIMBERLY ROBERTS WILKERSON
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Credential |
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Telephone | 305-735-4460
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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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