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General NPI Number Information
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NPI Number | 1699089425
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Entity Type | Organization
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Legal Business Name | CREW HOME CARE, INC
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 08/04/2010
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Provider Practice Location Address
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Address Line | 4454 WHITE OAK CIR
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City | KISSIMMEE
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State | FL
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Zip | 34746-5813
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Country | US
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Telephone | 321-437-3665
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Fax |
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Provider Business Mailing Address
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Address Line | 52 RILEY RD NO. 199
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City | CELEBRATION
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State | FL
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Zip | 34747-5420
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Country | US
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Telephone | 321-437-3665
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. ROBERT GARDNER PHILLIPS
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Credential |
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Telephone | 321-437-3665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 231776
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 376J00000X
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Taxonomy Name | Homemaker
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License Number | 231776
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License Number State | FL
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