Provider Demographics
NPI:1609025287
Name:BIDWELL HOME CARE SERVICE LLC
Entity Type:Organization
Organization Name:BIDWELL HOME CARE SERVICE LLC
Other - Org Name:HOME INSTEAD SENIOR CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BIDWELL
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:239-226-0007
Mailing Address - Street 1:16520 S TAMIAMI TRL
Mailing Address - Street 2:SUITE 213
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:SUITE 213
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:2008-09-18
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994400251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health