Provider Demographics
NPI:1649791823
Name:FLAGLER HOME CARE, LLC
Entity type:Organization
Organization Name:FLAGLER HOME CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:S
Authorized Official - Last Name:GORDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-819-4400
Mailing Address - Street 1:400 HEALTH PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-5784
Mailing Address - Country:US
Mailing Address - Phone:904-819-4400
Mailing Address - Fax:904-819-4472
Practice Address - Street 1:301 HEALTH PARK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5794
Practice Address - Country:US
Practice Address - Phone:904-824-2501
Practice Address - Fax:904-797-5774
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health