Provider Demographics
NPI:1740618230
Name:SHC HOME HEALTH SERVICES - LAKELAND, LLC
Entity Type:Organization
Organization Name:SHC HOME HEALTH SERVICES - LAKELAND, LLC
Other - Org Name:SIGNATURE HOMENOW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-568-7800
Mailing Address - Street 1:2322 LAKELAND HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2995
Mailing Address - Country:US
Mailing Address - Phone:863-644-5991
Mailing Address - Fax:
Practice Address - Street 1:2322 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2995
Practice Address - Country:US
Practice Address - Phone:863-644-5991
Practice Address - Fax:863-644-5992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
108437Medicare Oscar/Certification