MEDICARE: PLATINUM HOMECARE

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

General Provider Information

NPI Number	:	1932443074
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLATINUM HOMECARE

Provider Business Mailing Address
First Line	:	4767 NEW BROAD ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6405
Country	:	US
Telephone Number	:	407-514-2755
Fax Number	:

Provider Business Practice Location Address
First Line	:	4767 NEW BROAD ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32814-6405
Country	:	US
Telephone Number	:	407-514-2755
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	HEATHER KELLY
Credential	:	RN
Telephone Number	:	407-902-7918

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	11/15/2012

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Directions to “PLATINUM HOMECARE ” Practice Location

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