Provider Demographics
NPI:1629719729
Name:ADDLIFE CARE CONNECTION, LLC
Entity Type:Organization
Organization Name:ADDLIFE CARE CONNECTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANACE
Authorized Official - Middle Name:
Authorized Official - Last Name:ISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:904-293-5395
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32145-0101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:629 DANIELS ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:FL
Practice Address - Zip Code:32145-3201
Practice Address - Country:US
Practice Address - Phone:904-293-5395
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty