Provider Demographics
NPI:1407403975
Name:CICILY HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:CICILY HEALTH CARE SERVICES
Other - Org Name:CICILY CARES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR-MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-446-4510
Mailing Address - Street 1:2658 SW BRIGANTINE PL
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4319
Mailing Address - Country:US
Mailing Address - Phone:772-446-4510
Mailing Address - Fax:772-800-3067
Practice Address - Street 1:2658 SW BRIGANTINE PL
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4319
Practice Address - Country:US
Practice Address - Phone:772-446-4510
Practice Address - Fax:772-902-8277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
No347C00000XTransportation ServicesPrivate Vehicle
No385H00000XRespite Care FacilityRespite Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child