MEDICARE: NATURE COAST AT-HOME 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1063021236
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATURE COAST AT-HOME SERVICES, INC.

Provider Business Mailing Address
First Line	:	8293 NITTANY RD
Second Line	:
City	:	WEEKI WACHEE
State	:	FL
Zip	:	34613-5348
Country	:	US
Telephone Number	:	949-584-7010
Fax Number	:

Provider Business Practice Location Address
First Line	:	5327 COMMERCIAL WAY UNIT B105
Second Line	:
City	:	WEEKI WACHEE
State	:	FL
Zip	:	34606-1499
Country	:	US
Telephone Number	:	352-694-1087
Fax Number	:	352-648-0522

Authorized Official
Title or Position	:	OWNER AND PRESIDENT
Name	:	CHRISTINA BLUM
Credential	:	CSA
Telephone Number	:	352-694-1087

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	07/23/2020

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