Provider Demographics
NPI:1346686003
Name:PROFESSIONAL SENIOR CARE AND CONSULTING LLC
Entity Type:Organization
Organization Name:PROFESSIONAL SENIOR CARE AND CONSULTING LLC
Other - Org Name:PROFESSIONAL SENIOR CARE AND CONSULTING LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VESNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SAKALAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-246-7486
Mailing Address - Street 1:10260 CYPRESS VINE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7032
Mailing Address - Country:US
Mailing Address - Phone:321-246-7486
Mailing Address - Fax:407-816-6136
Practice Address - Street 1:10260 CYPRESS VINE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32827-7032
Practice Address - Country:US
Practice Address - Phone:321-246-7486
Practice Address - Fax:407-816-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-21
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232045305S00000X
372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes305S00000XManaged Care OrganizationsPoint of ServiceGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003407400Medicaid