=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922644855
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDIPRO HOME CARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2019
-----------------------------------------------------
Last Update Date | 11/26/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1070 LAKE FRANCIS DR
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32712-2114
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-270-5873
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 581 N PARK AVE # 4128581N
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32704-8601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-270-5873
-----------------------------------------------------
Fax | 407-612-2379
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. CAVEL SYLVIA ELLIOTT
-----------------------------------------------------
Credential | APRN
-----------------------------------------------------
Telephone | 516-270-5873
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------