MEDICARE: HERITAGE COMPANION CARE, LLC

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	:	1194605295
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERITAGE COMPANION CARE, LLC

Provider Business Mailing Address
First Line	:	1018 HAMPSHIRE AVE NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-3723
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1018 HAMPSHIRE AVE NE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-3723
Country	:	US
Telephone Number	:	321-451-0031
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CAMEILA MCPHERSON
Credential	:
Telephone Number	:	321-451-0031

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	09/08/2025

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