Provider Demographics
NPI:1629329313
Name:CLASSIC CARE OF FLORIDA, LLC
Entity Type:Organization
Organization Name:CLASSIC CARE OF FLORIDA, LLC
Other - Org Name:CLASSIC HOME HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-314-1885
Mailing Address - Street 1:1504 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-6630
Mailing Address - Country:US
Mailing Address - Phone:352-314-1885
Mailing Address - Fax:352-314-1890
Practice Address - Street 1:1504 SOUTH ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-6630
Practice Address - Country:US
Practice Address - Phone:352-314-1885
Practice Address - Fax:352-314-1890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-21
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991659251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
107786OtherMEDICARE PROVIDER NUMBER