Provider Demographics
NPI:1235223900
Name:HOME HEALTH AGENCY-HILLSBOROUGH, LLC
Entity Type:Organization
Organization Name:HOME HEALTH AGENCY-HILLSBOROUGH, LLC
Other - Org Name:SUNCREST OMNI
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF LICENSING/ACCREDITATION
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFADDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-712-2250
Mailing Address - Street 1:510 HOSPITAL DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MADISON
Mailing Address - State:TN
Mailing Address - Zip Code:37115-5033
Mailing Address - Country:US
Mailing Address - Phone:615-627-9267
Mailing Address - Fax:615-577-0081
Practice Address - Street 1:4910 14TH ST W
Practice Address - Street 2:SUITE 103
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-2405
Practice Address - Country:US
Practice Address - Phone:941-932-9118
Practice Address - Fax:941-932-9119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993406251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004159201Medicaid
FL299993406OtherSTATE LICENSE
FL10Q8070002Medicare Oscar/Certification