Provider Demographics
NPI:1649906330
Name:FLORIDA COMMUNITY HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:FLORIDA COMMUNITY HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:MONIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANTHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:267-262-3929
Mailing Address - Street 1:414 DERBY WAY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-2266
Mailing Address - Country:US
Mailing Address - Phone:267-262-3929
Mailing Address - Fax:
Practice Address - Street 1:172 MCCOY DR
Practice Address - Street 2:
Practice Address - City:LAKE PLACID
Practice Address - State:FL
Practice Address - Zip Code:33852-9552
Practice Address - Country:US
Practice Address - Phone:267-262-3929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty