Provider Demographics
NPI:1164699872
Name:SHIRLEY'S PERSONAL CARE SERVICES OF LEHIGH ACRES INC
Entity Type:Organization
Organization Name:SHIRLEY'S PERSONAL CARE SERVICES OF LEHIGH ACRES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:WEATHERFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-303-2422
Mailing Address - Street 1:45 ALABAMA RD N
Mailing Address - Street 2:SUITE # 3
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33936-6829
Mailing Address - Country:US
Mailing Address - Phone:239-303-2422
Mailing Address - Fax:239-303-2922
Practice Address - Street 1:45 ALABAMA RD N
Practice Address - Street 2:SUITE # 3
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6829
Practice Address - Country:US
Practice Address - Phone:239-303-2422
Practice Address - Fax:239-303-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211194251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687043101Medicaid