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General NPI Number Information
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NPI Number | 1982880688
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Entity Type | Organization
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Legal Business Name | FLORIDA SENIOR CARE SERVICES, LLC
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 01/14/2008
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Provider Practice Location Address
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Address Line | 5910 CARRIAGE LAKE CT
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City | VERO BEACH
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State | FL
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Zip | 32968-9476
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Country | US
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Telephone | 772-559-8673
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Fax | 772-564-8719
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Provider Business Mailing Address
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Address Line | PO BOX 691114
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City | VERO BEACH
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State | FL
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Zip | 32969-1114
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Country | US
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Telephone | 772-559-8673
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Fax | 772-564-8719
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Authorized Official
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Title or Position | VP BUSINESS DEVELOPMENT
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Name | MR. JERRY LLOYD TACKETT
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Credential | M.ED., BA, BS, AAMS.
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Telephone | 772-559-8673
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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 | SW6243
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number | SW6243
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | SW6243
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License Number State | FL
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