Provider Demographics
NPI:1639543762
Name:MICHELLES COMPANION SERVICE LLC
Entity Type:Organization
Organization Name:MICHELLES COMPANION SERVICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WELCOME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-225-2035
Mailing Address - Street 1:2512 NE 57TH BLVD LOT 48
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-5624
Mailing Address - Country:US
Mailing Address - Phone:352-225-2035
Mailing Address - Fax:352-374-8098
Practice Address - Street 1:2512 NE 57TH BLVD LOT 48
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-5624
Practice Address - Country:US
Practice Address - Phone:352-225-2035
Practice Address - Fax:352-374-8098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006643900Medicaid