=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598561706
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PCAH HERNANDO CARES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/20/2025
-----------------------------------------------------
Last Update Date | 02/20/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5172 MARINER BLVD # 100
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609-1802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-271-1328
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 511 PAINTED LEAF DR
-----------------------------------------------------
City | BROOKSVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34604-1463
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-271-1328
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | ADAM LEROUX
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-271-1328
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------