Provider Demographics
NPI:1760681480
Name:HOME COMPANIONS SPECIALISTS, LLC
Entity Type:Organization
Organization Name:HOME COMPANIONS SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WOLFF
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:850-433-0733
Mailing Address - Street 1:3 W GARDEN ST
Mailing Address - Street 2:SUITE 318 - 320
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-5641
Mailing Address - Country:US
Mailing Address - Phone:850-433-0733
Mailing Address - Fax:850-433-0734
Practice Address - Street 1:3 W GARDEN ST
Practice Address - Street 2:SUITE 318 - 320
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5641
Practice Address - Country:US
Practice Address - Phone:850-433-0733
Practice Address - Fax:850-433-0734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-12
Last Update Date:2008-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993399251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL692278300Medicaid