Provider Demographics
NPI:1700227329
Name:ETAIROS CARE AT HOME INC
Entity Type:Organization
Organization Name:ETAIROS CARE AT HOME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP REIMBURSEMENT
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:RAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-614-8300
Mailing Address - Street 1:13787 BELCHER RD S STE 220
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4065
Mailing Address - Country:US
Mailing Address - Phone:276-148-3007
Mailing Address - Fax:
Practice Address - Street 1:1255 37TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-6550
Practice Address - Country:US
Practice Address - Phone:772-567-2791
Practice Address - Fax:772-365-2733
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE WELLNESS SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-11
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991293251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107625Medicare Oscar/Certification