Provider Demographics
NPI:1417525312
Name:MS PHYLLIS HOME CARE LLC
Entity Type:Organization
Organization Name:MS PHYLLIS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFRED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-321-2727
Mailing Address - Street 1:1121 STRATTON AVE
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-8203
Mailing Address - Country:US
Mailing Address - Phone:321-209-1322
Mailing Address - Fax:407-386-7774
Practice Address - Street 1:16903 LAKESIDE DR STE 4
Practice Address - Street 2:
Practice Address - City:MONTVERDE
Practice Address - State:FL
Practice Address - Zip Code:34756-3230
Practice Address - Country:US
Practice Address - Phone:321-209-1322
Practice Address - Fax:407-386-7774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-16
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No385H00000XRespite Care FacilityRespite Care