Provider Demographics
NPI:1558799049
Name:SHC HOME HEALTH SERVICES - LONGWOOD, LLC
Entity Type:Organization
Organization Name:SHC HOME HEALTH SERVICES - LONGWOOD, 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 1:1205 ADMIRALTY BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5201
Mailing Address - Country:US
Mailing Address - Phone:321-338-2979
Mailing Address - Fax:321-735-4946
Practice Address - Street 1:1205 ADMIRALTY BLVD
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5201
Practice Address - Country:US
Practice Address - Phone:321-338-2979
Practice Address - Fax:321-735-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
108427Medicare Oscar/Certification