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General NPI Number Information
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NPI Number | 1710381553
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Entity Type | Organization
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Legal Business Name | BINGO HOME CARE, LLC
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Dates
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Enumeration Date | 10/21/2014
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 16913 LAKESIDE DR STE 13
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City | MONTVERDE
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State | FL
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Zip | 34756-3243
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Country | US
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Telephone | 407-223-3111
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Fax | 407-614-3978
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Provider Business Mailing Address
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Address Line | 16913 LAKESIDE DR STE 13
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City | MONTVERDE
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State | FL
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Zip | 34756-3243
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Country | US
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Telephone | 407-469-0061
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Fax | 407-614-3978
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Authorized Official
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Title or Position | OWNER
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Name | MRS. EDMOND ILVERT
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Credential |
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Telephone | 407-223-3111
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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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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State | FL
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