Provider Demographics
NPI:1760678767
Name:HEALTH CARE SERVICES POOL, LLC
Entity Type:Organization
Organization Name:HEALTH CARE SERVICES POOL, LLC
Other - Org Name:PRO SERV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDOLPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:KERNON
Authorized Official - Suffix:II
Authorized Official - Credentials:LNHA
Authorized Official - Phone:386-257-4400
Mailing Address - Street 1:595 N WILLIAMSON BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-7185
Mailing Address - Country:US
Mailing Address - Phone:386-257-4400
Mailing Address - Fax:386-257-4372
Practice Address - Street 1:595 N WILLIAMSON BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-7185
Practice Address - Country:US
Practice Address - Phone:386-257-4400
Practice Address - Fax:386-257-4372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-24
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No251J00000XAgenciesNursing CareGroup - Single Specialty