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General NPI Number Information
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NPI Number | 1790345627
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Entity Type | Organization
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Legal Business Name | CARETENDERS VISITING SERVICES OF ST. AUGUSTINE, LLC
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Dates
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Enumeration Date | 06/13/2019
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 310 WILMETTE AVE STE 4
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5276
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Country | US
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Telephone | 386-615-2053
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Fax | 386-676-2173
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Provider Business Mailing Address
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Address Line | PO BOX 51266
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City | LAFAYETTE
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State | LA
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Zip | 70505-1266
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Country | US
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Telephone | 337-233-1307
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Fax | 337-233-5764
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONALD D. STELLY
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Credential |
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Telephone | 337-233-1307
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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