Provider Demographics
NPI:1013334358
Name:HEALTH AND HOME CARE SERVICES OF LAKE HELEN LLC.
Entity type:Organization
Organization Name:HEALTH AND HOME CARE SERVICES OF LAKE HELEN LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED HOME HEALTH AIDE
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:COSTEN
Authorized Official - Suffix:
Authorized Official - Credentials:HHA
Authorized Official - Phone:386-473-2010
Mailing Address - Street 1:105 CHESTNUT LN
Mailing Address - Street 2:
Mailing Address - City:LAKE HELEN
Mailing Address - State:FL
Mailing Address - Zip Code:32744-3109
Mailing Address - Country:US
Mailing Address - Phone:386-473-2010
Mailing Address - Fax:
Practice Address - Street 1:105 CHESTNUT LN
Practice Address - Street 2:
Practice Address - City:LAKE HELEN
Practice Address - State:FL
Practice Address - Zip Code:32744-3109
Practice Address - Country:US
Practice Address - Phone:386-473-2010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL130098251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL130098OtherHOME HEALTH AIDE CERTIFICATION
FL3269OtherALPI TECHNICAL EDUCATION CENTER