MEDICARE: BAYCARE HOME CARE, 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	HHA21070096	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

General Provider Information

NPI Number	:	1952309171
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAYCARE HOME CARE, INC.

Provider Business Mailing Address
First Line	:	20 LAKE WIRE DR STE 230
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33815-1566
Country	:	US
Telephone Number	:	863-665-8866
Fax Number	:	863-665-8101

Provider Business Practice Location Address
First Line	:	20 LAKE WIRE DR STE 230
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33815-1566
Country	:	US
Telephone Number	:	863-665-8866
Fax Number	:	863-665-8101

Authorized Official
Title or Position	:	DIRECTOR
Name	:	TIMISI C JOHNSON
Credential	:	RN
Telephone Number	:	727-470-4609

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	06/20/2025

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