MEDICARE: PURPLE MEDI-CARE.COM 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9901	OTHER	FL	TRANSPORTATION AND HOME COMPANION

General Provider Information

NPI Number	:	1780381434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURPLE MEDI-CARE.COM INC

Provider Business Mailing Address
First Line	:	2150 SOUTEL DR STE 8
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-2281
Country	:	US
Telephone Number	:	904-437-4034
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 SOUTEL DR STE 8
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32208-2281
Country	:	US
Telephone Number	:	904-437-4034
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	PATRINYA JORDAN
Credential	:
Telephone Number	:	904-479-2051

Provider Enumeration Date	:	02/13/2023
Last Update Date	:	05/31/2023

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