Provider Demographics
NPI:1629600465
Name:CLASSIC HOMECARE, LLC
Entity Type:Organization
Organization Name:CLASSIC HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-413-0038
Mailing Address - Street 1:PO BOX 541231
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32954-1231
Mailing Address - Country:US
Mailing Address - Phone:321-413-0038
Mailing Address - Fax:954-929-4488
Practice Address - Street 1:2235 N COURTENAY PKWY STE 2M
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-5227
Practice Address - Country:US
Practice Address - Phone:954-929-4888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care