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General NPI Number Information
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NPI Number | 1598208688
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Entity Type | Organization
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Legal Business Name | PURE DIVERSITY HOMEMAKER COMPANION SERVICE, LLC
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Dates
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Enumeration Date | 11/22/2016
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Last Update Date | 11/22/2016
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Provider Practice Location Address
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Address Line | 1061 MAITLAND CENTER COMMONS BLVD SUITE # 214
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City | MAITLAND
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State | FL
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Zip | 32751-7435
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Country | US
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Telephone | 407-775-1502
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Fax |
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Provider Business Mailing Address
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Address Line | 1061 MAITLAND CENTER COMMONS BLVD SUITE # 214
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City | MAITLAND
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State | FL
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Zip | 32751-7435
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Country | US
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Telephone | 407-775-1502
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Fax |
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Authorized Official
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Title or Position | HHA/OWNER
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Name | MISS LATANYA LAVETTE MAGWOOD
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Credential | NURSES ASSISTANT
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Telephone | 407-775-1502
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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 | 233943
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License Number State | FL
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