MEDICARE: LEE COMMUNITY HOME HEALTHCARE 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	251E00000X	Home Health Agency

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

General Provider Information

NPI Number	:	1912506288
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE COMMUNITY HOME HEALTHCARE INC

Provider Business Mailing Address
First Line	:	1408 SE 17TH AVE STE E
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3801
Country	:	US
Telephone Number	:	239-800-4861
Fax Number	:	239-800-4861

Provider Business Practice Location Address
First Line	:	1408 SE 17TH AVE STE E
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3801
Country	:	US
Telephone Number	:	239-800-4861
Fax Number	:	239-800-4861

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	IVELISSE GONZALEZ
Credential	:	RN
Telephone Number	:	239-800-4861

Provider Enumeration Date	:	10/19/2020
Last Update Date	:	05/10/2021

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Directions to “LEE COMMUNITY HOME HEALTHCARE INC ” Practice Location

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