Provider Demographics
NPI:1104387745
Name:TARA UNLIMITED HOME CARE,LLC
Entity Type:Organization
Organization Name:TARA UNLIMITED HOME CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PROCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-315-0149
Mailing Address - Street 1:2124 PARADISE POINT LN
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-9406
Mailing Address - Country:US
Mailing Address - Phone:321-315-0149
Mailing Address - Fax:
Practice Address - Street 1:2124 PARADISE POINT LN
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-9406
Practice Address - Country:US
Practice Address - Phone:321-315-0149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02136600Medicaid
FL021366000Medicaid