Provider Demographics
NPI: | 1164662169 |
---|---|
Name: | YOUR HOME COMPANION |
Entity Type: | Organization |
Organization Name: | YOUR HOME COMPANION |
Other - Org Name: | BLUEWATER STAFFING, LLC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER/HOMEMAKER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | LAURA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BARBIN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 727-388-1698 |
Mailing Address - Street 1: | 4604 49TH ST N |
Mailing Address - Street 2: | 11 |
Mailing Address - City: | ST PETERSBURG |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33709-3842 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 727-388-1698 |
Mailing Address - Fax: | 727-388-6679 |
Practice Address - Street 1: | 844 27TH AVE N |
Practice Address - Street 2: | |
Practice Address - City: | ST PETERSBURG |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33704-2708 |
Practice Address - Country: | US |
Practice Address - Phone: | 727-388-1698 |
Practice Address - Fax: | 727-388-6679 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-03-03 |
Last Update Date: | 2009-03-03 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | 230441 | 253Z00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 253Z00000X | Agencies | In Home Supportive Care |