Provider Demographics
NPI:1063675981
Name:SHIRLEY'S PERSONAL CARE SERVICES OF OKEECHOBEE, INC.
Entity Type:Organization
Organization Name:SHIRLEY'S PERSONAL CARE SERVICES OF OKEECHOBEE, INC.
Other - Org Name:SHIRLEY'S PERSONAL CARE SVC OKEECHOBEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-467-6399
Mailing Address - Street 1:200 SOUTHEAST THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34974
Mailing Address - Country:US
Mailing Address - Phone:863-467-6399
Mailing Address - Fax:863-467-4087
Practice Address - Street 1:200 SOUTHEAST THIRD STREET
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34974
Practice Address - Country:US
Practice Address - Phone:863-467-6399
Practice Address - Fax:863-467-4087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211249251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690179400Medicaid