Provider Demographics
NPI:1407284771
Name:SHC HOME HEALTH SERVICES - PORT CHARLOTTE, LLC
Entity Type:Organization
Organization Name:SHC HOME HEALTH SERVICES - PORT CHARLOTTE, LLC
Other - Org Name:SIGNATURE HOMENOW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-568-7800
Mailing Address - Street 1:1630 MEDICAL LN
Mailing Address - Street 2:SUITE C
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1129
Mailing Address - Country:US
Mailing Address - Phone:239-274-9124
Mailing Address - Fax:239-337-9599
Practice Address - Street 1:1630 MEDICAL LN
Practice Address - Street 2:SUITE C
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-1129
Practice Address - Country:US
Practice Address - Phone:239-274-9124
Practice Address - Fax:239-337-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
108433Medicare Oscar/Certification