MEDICARE: PURPLE ORCHID HOME CARE SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1023699626
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURPLE ORCHID HOME CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	381 PALM COAST PKWY SW UNIT 4
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-4782
Country	:	US
Telephone Number	:	386-276-9001
Fax Number	:	386-585-4402

Provider Business Practice Location Address
First Line	:	381 PALM COAST PKWY SW UNIT 4
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32137-4782
Country	:	US
Telephone Number	:	386-276-9001
Fax Number	:	386-585-4402

Authorized Official
Title or Position	:	DIRECTOR/CEO
Name	:	MRS. ALVATINA L. DAVIS
Credential	:	LPN
Telephone Number	:	386-276-9001

Provider Enumeration Date	:	04/16/2021
Last Update Date	:	04/16/2021

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