=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225773344
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MHC AREA 5, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2022
-----------------------------------------------------
Last Update Date | 11/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28100 US HWY 19 N STE 411
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33761-2655
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-284-6039
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6001 BROKEN SOUND PKWY NW STE 220
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33487-2754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-891-0786
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR OF CLINICAL SERVICES
-----------------------------------------------------
Name | KRISTI JACKSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 941-257-4285
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------