MEDICARE: COMPLETE HOME CARE - PRIVATE DUTY 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1568239812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPLETE HOME CARE - PRIVATE DUTY LLC

Provider Business Mailing Address
First Line	:	5601 EXECUTIVE DR STE 250
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-2508
Country	:	US
Telephone Number	:	972-677-3471
Fax Number	:

Provider Business Practice Location Address
First Line	:	3181 N BAY VILLAGE CT STE A-201
Second Line	:
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-7222
Country	:	US
Telephone Number	:	941-867-7581
Fax Number	:	941-867-8751

Authorized Official
Title or Position	:	SECRETARY
Name	:	MR. JONATHAN FUNSTON
Credential	:
Telephone Number	:	706-877-0838

Provider Enumeration Date	:	12/07/2023
Last Update Date	:	04/29/2025

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