MEDICARE: MISS DAISY'S HOME HEALTH AGENCY, 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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1982239950
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISS DAISY'S HOME HEALTH AGENCY, LLC

Provider Business Mailing Address
First Line	:	5051 CASTELLO DRIVE
Second Line	:	STE. 25
City	:	NAPLES
State	:	FL
Zip	:	34103
Country	:	US
Telephone Number	:	239-228-5351
Fax Number	:	239-228-5349

Provider Business Practice Location Address
First Line	:	5051 CASTELLO DRIVE
Second Line	:	STE. 25/26
City	:	NAPLES
State	:	FL
Zip	:	34103-8959
Country	:	US
Telephone Number	:	239-228-5351
Fax Number	:	239-228-5349

Authorized Official
Title or Position	:	PRESIDENT/ADMINISTRATOR
Name	:	MS. CHRISTINE KOWALSKI
Credential	:
Telephone Number	:	239-877-9568

Provider Enumeration Date	:	03/10/2020
Last Update Date	:	05/18/2023

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