Provider Demographics
NPI:1710381553
Name:BINGO HOME CARE, LLC
Entity Type:Organization
Organization Name:BINGO HOME CARE, LLC
Other - Org Name:TOUCH FROM ABOVE HOME CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDMOND
Authorized Official - Middle Name:
Authorized Official - Last Name:ILVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-223-3111
Mailing Address - Street 1:16913 LAKESIDE DR STE 13
Mailing Address - Street 2:
Mailing Address - City:MONTVERDE
Mailing Address - State:FL
Mailing Address - Zip Code:34756-3243
Mailing Address - Country:US
Mailing Address - Phone:407-469-0061
Mailing Address - Fax:407-614-3978
Practice Address - Street 1:16913 LAKESIDE DR STE 13
Practice Address - Street 2:
Practice Address - City:MONTVERDE
Practice Address - State:FL
Practice Address - Zip Code:34756-3243
Practice Address - Country:US
Practice Address - Phone:407-223-3111
Practice Address - Fax:407-614-3978
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOUCH FROM ABOVE HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-21
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30212447OtherAHCA NURSE REGISTRY LICENSE
FL232894/232908OtherAHCA REGISTRATION # 232894/232908
FL022269900Medicaid
FL116181400Medicaid