=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982313714
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S&G HOME CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/21/2022
-----------------------------------------------------
Last Update Date | 12/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3118 GULF TO BAY BLVD
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33759-4553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-907-9007
-----------------------------------------------------
Fax | 859-441-1462
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3118 GULF TO BAY BLVD
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33759-4553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-907-9007
-----------------------------------------------------
Fax | 859-441-1462
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMIN
-----------------------------------------------------
Name | JULIE FINN
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 859-638-7550
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------