Provider Demographics
NPI:1942459078
Name:CRQ ENTERPRISES LLC
Entity Type:Organization
Organization Name:CRQ ENTERPRISES LLC
Other - Org Name:HOME INSTEAD SENIOR CARE OF CITRUS COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:QUINTANILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-249-1257
Mailing Address - Street 1:4214 W GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461
Mailing Address - Country:US
Mailing Address - Phone:352-249-1257
Mailing Address - Fax:352-249-1260
Practice Address - Street 1:4214 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461
Practice Address - Country:US
Practice Address - Phone:352-249-1257
Practice Address - Fax:352-249-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993253251E00000X
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001381400Medicaid