Provider Demographics
NPI:1538634068
Name:POINCIANA PERSONAL CARE & COMPANION SERVICES CORP
Entity Type:Organization
Organization Name:POINCIANA PERSONAL CARE & COMPANION SERVICES CORP
Other - Org Name:POINCIANA NURSE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-350-4138
Mailing Address - Street 1:PO BOX 452848
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34745-2848
Mailing Address - Country:US
Mailing Address - Phone:407-350-4138
Mailing Address - Fax:321-250-7463
Practice Address - Street 1:105 E MONUMENT AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5761
Practice Address - Country:US
Practice Address - Phone:407-350-4138
Practice Address - Fax:321-250-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-11
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No251J00000XAgenciesNursing Care
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106008100Medicaid