Provider Demographics
NPI:1457586737
Name:CARETENDERS VISITING SERVICES OF DISTRICT 6, LLC
Entity Type:Organization
Organization Name:CARETENDERS VISITING SERVICES OF DISTRICT 6, LLC
Other - Org Name:MEDERI CARETENDERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GACHASSIN
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:337-233-1307
Mailing Address - Street 1:9510 ORMSBY STATION RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-4081
Mailing Address - Country:US
Mailing Address - Phone:502-891-1000
Mailing Address - Fax:502-891-8067
Practice Address - Street 1:18501 MURDOCK CIR STE 502
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1065
Practice Address - Country:US
Practice Address - Phone:941-764-7555
Practice Address - Fax:941-764-1063
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARETENDERS VISITING SERVICES OF DISTRICT 6, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-15
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL107485Medicare Oscar/Certification