MEDICARE: CREATIVE SENIOR IN HOME CARE SERVICE 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

General Provider Information

NPI Number	:	1972006286
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CREATIVE SENIOR IN HOME CARE SERVICE LLC

Provider Business Mailing Address
First Line	:	6151 LAKE OSPREY DR FL 3
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34240-8419
Country	:	US
Telephone Number	:	941-373-1400
Fax Number	:	941-373-1401

Provider Business Practice Location Address
First Line	:	6151 LAKE OSPREY DR FL 3
Second Line	:
City	:	LAKEWOOD RANCH
State	:	FL
Zip	:	34240-8419
Country	:	US
Telephone Number	:	941-373-1400
Fax Number	:	941-373-1401

Authorized Official
Title or Position	:	OWNER
Name	:	EARL ACOSTA
Credential	:
Telephone Number	:	813-995-5574

Provider Enumeration Date	:	03/13/2018
Last Update Date	:	03/13/2018

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