Provider Demographics
NPI:1720568587
Name:REED PRESTIGIOUS CAREGIVING INCORPORATION
Entity Type:Organization
Organization Name:REED PRESTIGIOUS CAREGIVING INCORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:GARRIDO
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-584-5373
Mailing Address - Street 1:PO BOX 881054
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34988-1054
Mailing Address - Country:US
Mailing Address - Phone:772-584-5373
Mailing Address - Fax:
Practice Address - Street 1:4280 SW SAVONA BLVD
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-7242
Practice Address - Country:US
Practice Address - Phone:772-584-5373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL725454Medicaid