MEDICARE: SENIOR CARE OF NE FLORIDA, 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
2	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1912637075
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENIOR CARE OF NE FLORIDA, LLC.

Provider Business Mailing Address
First Line	:	10151 DEERWOOD PARK BLVD. BLDG. 200 STE 250
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7302
Country	:	US
Telephone Number	:	904-344-8826
Fax Number	:

Provider Business Practice Location Address
First Line	:	10151 DEERWOOD PARK BLVD. BLDG. 200 STE 250
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-7302
Country	:	US
Telephone Number	:	904-344-8826
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. TYLER WHITMAN
Credential	:
Telephone Number	:	407-949-8272

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	03/30/2023

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