MEDICARE: HOME HEALTH AGENCY - PINELLAS, 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	299991597	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801880653
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME HEALTH AGENCY - PINELLAS, LLC

Provider Business Mailing Address
First Line	:	9510 ORMSBY STATION RD STE 300
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-5016
Country	:	US
Telephone Number	:	502-891-1000
Fax Number	:	502-891-1427

Provider Business Practice Location Address
First Line	:	7330 LITTLE RD STE 101
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34654-5571
Country	:	US
Telephone Number	:	502-891-1000
Fax Number	:	502-891-1427

Authorized Official
Title or Position	:	SR. VP ADMINISTRATION
Name	:	PATRICK T. LYLES
Credential	:
Telephone Number	:	502-891-1044

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/21/2022

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