Provider Demographics
NPI:1750562567
Name:CROWN HOME CARE INC
Entity type:Organization
Organization Name:CROWN HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIENNE
Authorized Official - Middle Name:O
Authorized Official - Last Name:GORDON-WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:407-933-7570
Mailing Address - Street 1:1130 E DONEGAN AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-1918
Mailing Address - Country:US
Mailing Address - Phone:407-933-7570
Mailing Address - Fax:407-933-7571
Practice Address - Street 1:1130 E DONEGAN AVE
Practice Address - Street 2:SUITE 8
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1918
Practice Address - Country:US
Practice Address - Phone:407-933-7570
Practice Address - Fax:407-933-7571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992933251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health