Provider Demographics
NPI:1376796847
Name:CELEBRITY STYLE HOMEMAKER & COMPANION SERVICES INC.
Entity Type:Organization
Organization Name:CELEBRITY STYLE HOMEMAKER & COMPANION SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPERATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-278-6645
Mailing Address - Street 1:1325 16TH ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-2338
Mailing Address - Country:US
Mailing Address - Phone:727-278-6645
Mailing Address - Fax:
Practice Address - Street 1:1325 16TH ST S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-2338
Practice Address - Country:US
Practice Address - Phone:727-278-6645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230098253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691878698Medicaid
FL691878696Medicaid