Provider Demographics
NPI:1598208688
Name:PURE DIVERSITY HOMEMAKER COMPANION SERVICE, LLC
Entity Type:Organization
Organization Name:PURE DIVERSITY HOMEMAKER COMPANION SERVICE, LLC
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:HHA/OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LATANYA
Authorized Official - Middle Name:LAVETTE
Authorized Official - Last Name:MAGWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:NURSES ASSISTANT
Authorized Official - Phone:407-775-1502
Mailing Address - Street 1:1061 MAITLAND CENTER COMMONS BLVD
Mailing Address - Street 2:SUITE # 214
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7435
Mailing Address - Country:US
Mailing Address - Phone:407-775-1502
Mailing Address - Fax:
Practice Address - Street 1:1061 MAITLAND CENTER COMMONS BLVD
Practice Address - Street 2:SUITE # 214
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7435
Practice Address - Country:US
Practice Address - Phone:407-775-1502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233943251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health