Provider Demographics
NPI:1114080967
Name:EMERALD HOME HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:EMERALD HOME HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JOYCE
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-442-2350
Mailing Address - Street 1:2420 ENTERPRISE RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1703
Mailing Address - Country:US
Mailing Address - Phone:727-442-2350
Mailing Address - Fax:727-442-2860
Practice Address - Street 1:2420 ENTERPRISE RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1703
Practice Address - Country:US
Practice Address - Phone:727-442-2350
Practice Address - Fax:727-442-2860
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992701251E00000X
FL800022197291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299992701OtherAHCA HHA LICENSE NUMBER
FL800022197OtherCLIA