=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912411836
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARE AGENCY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2017
-----------------------------------------------------
Last Update Date | 03/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 137 S PEBBLE BEACH BLVD STE 101
-----------------------------------------------------
City | SUN CITY CENTER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33573-5708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-899-8665
-----------------------------------------------------
Fax | 772-209-5970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 137 S PEBBLE BEACH BLVD STE 101
-----------------------------------------------------
City | SUN CITY CENTER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33573-5708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 888-899-8665
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | THALIA SHURNS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-538-5008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------