Provider Demographics
NPI:1710362066
Name:WALKERCHOICE PERSONAL & COMPANION CARE SERVICES
Entity Type:Organization
Organization Name:WALKERCHOICE PERSONAL & COMPANION CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:A
Authorized Official - Last Name:RANDOLPH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-625-0416
Mailing Address - Street 1:11312 JIM CT
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5965
Mailing Address - Country:US
Mailing Address - Phone:813-625-0416
Mailing Address - Fax:813-498-0922
Practice Address - Street 1:11312 JIM CT
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5965
Practice Address - Country:US
Practice Address - Phone:813-625-0416
Practice Address - Fax:813-498-0922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-28
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233281251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health