MEDICARE: ESSENTIAL FAMILY SERVICES,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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1952775660
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESSENTIAL FAMILY SERVICES,LLC

Provider Business Mailing Address
First Line	:	2219 MALLORY CIR
Second Line	:
City	:	HAINES CITY
State	:	FL
Zip	:	33844-2412
Country	:	US
Telephone Number	:	863-207-2289
Fax Number	:

Provider Business Practice Location Address
First Line	:	705 INGRAHAM AVE
Second Line	:	SUITE #6
City	:	HAINES CITY
State	:	FL
Zip	:	33844-4327
Country	:	US
Telephone Number	:	863-207-2289
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MICHELLE RODRIGUEZ
Credential	:
Telephone Number	:	863-207-2289

Provider Enumeration Date	:	11/18/2015
Last Update Date	:	07/22/2016

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