Provider Demographics
NPI:1578346797
Name:PINE ISLAND WELLNESS AT HOME LLC
Entity Type:Organization
Organization Name:PINE ISLAND WELLNESS AT HOME LLC
Other - Org Name:WELLNESS AT HOME SENIOR CONCIERGE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER - FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JODY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRANKE
Authorized Official - Suffix:
Authorized Official - Credentials:COTA-L, CAPS
Authorized Official - Phone:239-940-0767
Mailing Address - Street 1:4020 PINETREE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33956-2429
Mailing Address - Country:US
Mailing Address - Phone:239-940-0767
Mailing Address - Fax:
Practice Address - Street 1:4480 STRINGFELLOW RD UNIT 86
Practice Address - Street 2:
Practice Address - City:SAINT JAMES CITY
Practice Address - State:FL
Practice Address - Zip Code:33956-2414
Practice Address - Country:US
Practice Address - Phone:941-202-4005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PINE ISLAND WELLNESS AT HOME LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-14
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty