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General NPI Number Information
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NPI Number | 1598651010
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Entity Type | Organization
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Legal Business Name | FIVE STAR PROFESSIONAL HOME CARE STAFFING 2
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 570 AVENUE J SE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3709
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Country | US
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Telephone | 904-673-8416
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Fax | 904-661-1916
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Provider Business Mailing Address
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Address Line | 4131 UNIVERSITY BLVD S STE 12
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4352
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Country | US
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Telephone | 904-673-8416
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Fax | 904-661-1916
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Authorized Official
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Title or Position | OWNER
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Name | MELONIE MILLER
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Credential |
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Telephone | 904-673-8416
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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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