Provider Demographics
NPI:1720552284
Name:WYNNTER SPRINGS PRIVATE HOME CARE, LLP
Entity Type:Organization
Organization Name:WYNNTER SPRINGS PRIVATE HOME CARE, LLP
Other - Org Name:WYNNTER SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-434-1886
Mailing Address - Street 1:PO BOX 564
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:AL
Mailing Address - Zip Code:35127-0564
Mailing Address - Country:US
Mailing Address - Phone:205-434-1886
Mailing Address - Fax:
Practice Address - Street 1:956 6TH ST
Practice Address - Street 2:
Practice Address - City:PLEASANT GROVE
Practice Address - State:AL
Practice Address - Zip Code:35127-1506
Practice Address - Country:US
Practice Address - Phone:205-434-1886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-17
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care