MEDICARE: EAST COAST SCB 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	:	1740167394
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST COAST SCB LLC

Provider Business Mailing Address
First Line	:	2910 KERRY FOREST PKWY STE D4227
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-6892
Country	:	US
Telephone Number	:	850-765-4729
Fax Number	:

Provider Business Practice Location Address
First Line	:	2910 KERRY FOREST PKWY STE D4227
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32309-6892
Country	:	US
Telephone Number	:	850-765-4729
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	MS. SHARON E WEEDEN
Credential	:
Telephone Number	:	850-765-4729

Provider Enumeration Date	:	08/18/2025
Last Update Date	:	08/18/2025

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