Provider Demographics
NPI:1821082041
Name:HOME CARE OF PINELLAS
Entity Type:Organization
Organization Name:HOME CARE OF PINELLAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:727-797-5173
Mailing Address - Street 1:1801 N BELCHER RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1452
Mailing Address - Country:US
Mailing Address - Phone:727-797-5173
Mailing Address - Fax:727-797-4639
Practice Address - Street 1:1801 N BELCHER RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1452
Practice Address - Country:US
Practice Address - Phone:727-797-5173
Practice Address - Fax:727-797-4639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108124Medicare Oscar/Certification