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General NPI Number Information
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NPI Number | 1629329313
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Entity Type | Organization
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Legal Business Name | CLASSIC CARE OF FLORIDA, LLC
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Dates
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Enumeration Date | 09/21/2012
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Last Update Date | 08/02/2013
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Provider Practice Location Address
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Address Line | 1504 SOUTH ST
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City | LEESBURG
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State | FL
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Zip | 34748-6630
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Country | US
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Telephone | 352-314-1885
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Fax | 352-314-1890
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Provider Business Mailing Address
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Address Line | 1504 SOUTH ST
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City | LEESBURG
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State | FL
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Zip | 34748-6630
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Country | US
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Telephone | 352-314-1885
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Fax | 352-314-1890
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Authorized Official
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Title or Position | CEO
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Name | MS. JUNE K LEW
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Credential |
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Telephone | 352-314-1885
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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 | 299991659
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License Number State | FL
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