Provider Demographics
NPI:1467754051
Name:BIDWELL SERVICE CARE LLC
Entity Type:Organization
Organization Name:BIDWELL SERVICE CARE LLC
Other - Org Name:HOME INSTEAD SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BIDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-226-0007
Mailing Address - Street 1:16520 S TAMIAMI TRL
Mailing Address - Street 2:SUITE241
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-4569
Mailing Address - Country:US
Mailing Address - Phone:239-226-0007
Mailing Address - Fax:239-226-0022
Practice Address - Street 1:16520 S TAMIAMI TRL
Practice Address - Street 2:SUITE241
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4569
Practice Address - Country:US
Practice Address - Phone:239-226-0007
Practice Address - Fax:239-226-0022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993091251E00000X
FL228825253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL685223800Medicaid