Provider Demographics
NPI:1003548934
Name:WILCOX HOMECARE LLC
Entity Type:Organization
Organization Name:WILCOX HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-614-8287
Mailing Address - Street 1:1635 S RIDGEWOOD AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SOUTH DAYTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32119-8425
Mailing Address - Country:US
Mailing Address - Phone:321-614-8287
Mailing Address - Fax:386-271-3607
Practice Address - Street 1:1635 S RIDGEWOOD AVE STE 102
Practice Address - Street 2:
Practice Address - City:SOUTH DAYTONA
Practice Address - State:FL
Practice Address - Zip Code:32119-8425
Practice Address - Country:US
Practice Address - Phone:321-614-8287
Practice Address - Fax:386-271-3607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care