Provider Demographics
NPI:1134188816
Name:UNITED HOME CARE SERVICES OF SOUTHWEST FLORIDA, LLC
Entity type:Organization
Organization Name:UNITED HOME CARE SERVICES OF SOUTHWEST FLORIDA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HEUBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-381-7844
Mailing Address - Street 1:10070 DANIELS INTERSTATE CT
Mailing Address - Street 2:#130
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-7876
Mailing Address - Country:US
Mailing Address - Phone:239-278-3032
Mailing Address - Fax:239-278-3780
Practice Address - Street 1:10070 DANIELS INTERSTATE CT
Practice Address - Street 2:#130
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-7876
Practice Address - Country:US
Practice Address - Phone:239-278-3032
Practice Address - Fax:239-278-3780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299991516251E00000X
FL299991516251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10-7661OtherCCN
107661Medicare PIN