Provider Demographics
NPI:1831648930
Name:FOUR NINETEEN, LLC
Entity Type:Organization
Organization Name:FOUR NINETEEN, LLC
Other - Org Name:HOMEWATCH CAREGIVERS OF LAKEWOOD RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:HAITZ
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:941-920-0826
Mailing Address - Street 1:9015 TOWN CENTER PKWY
Mailing Address - Street 2:#104
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-5012
Mailing Address - Country:US
Mailing Address - Phone:941-920-0826
Mailing Address - Fax:
Practice Address - Street 1:9015 TOWN CENTER PKWY
Practice Address - Street 2:#104
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-5012
Practice Address - Country:US
Practice Address - Phone:941-920-0826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994641251E00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care