Provider Demographics
NPI:1639630726
Name:E & N COMPANION CARE LLC
Entity Type:Organization
Organization Name:E & N COMPANION CARE LLC
Other - Org Name:CHAMPION HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTANCUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-287-5432
Mailing Address - Street 1:130 SW MONTEREY RD
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-4610
Mailing Address - Country:US
Mailing Address - Phone:772-287-5432
Mailing Address - Fax:772-497-7012
Practice Address - Street 1:130 SW MONTEREY RD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-4610
Practice Address - Country:US
Practice Address - Phone:772-287-5432
Practice Address - Fax:772-497-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-29
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102557600Medicaid