=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568202190
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HISC239, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2024
-----------------------------------------------------
Last Update Date | 05/30/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 216 N 3RD ST STE A
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34748-5197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-323-6100
-----------------------------------------------------
Fax | 352-414-4481
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 216 N 3RD ST STE A
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34748-5197
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-323-6100
-----------------------------------------------------
Fax | 352-414-4481
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. PAUL E KING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-525-5157
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------