Provider Demographics
NPI:1700049970
Name:SHIRLEY'S PERSONAL CARE SERVICES, INC.
Entity Type:Organization
Organization Name:SHIRLEY'S PERSONAL CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ALTERNATE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JOHNNIE
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-223-4620
Mailing Address - Street 1:1045 SE OCEAN BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-2538
Mailing Address - Country:US
Mailing Address - Phone:772-223-4620
Mailing Address - Fax:772-287-1424
Practice Address - Street 1:1045 SE OCEAN BLVD STE 5
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-2538
Practice Address - Country:US
Practice Address - Phone:772-223-4620
Practice Address - Fax:772-287-1424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNR30211065251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL687043100Medicaid