Provider Demographics
NPI:1184922668
Name:ISLAND HOME CARE AGENCY, INC
Entity type:Organization
Organization Name:ISLAND HOME CARE AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ROBERTS
Authorized Official - Last Name:WILKERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-735-4460
Mailing Address - Street 1:1200 4TH ST
Mailing Address - Street 2:SUITE 179
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-3763
Mailing Address - Country:US
Mailing Address - Phone:305-735-4460
Mailing Address - Fax:305-453-6186
Practice Address - Street 1:817 SIMONTON ST
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-7445
Practice Address - Country:US
Practice Address - Phone:305-735-4460
Practice Address - Fax:305-453-6186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-07
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health