Provider Demographics
NPI:1770586257
Name:VISITING NURSE COMMUNITY CARE OF THE WEST COAST, INC.
Entity type:Organization
Organization Name:VISITING NURSE COMMUNITY CARE OF THE WEST COAST, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:S
Authorized Official - Last Name:CROW
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:772-286-1844
Mailing Address - Street 1:2400 SE MONTEREY RD STE 300
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34996-3351
Mailing Address - Country:US
Mailing Address - Phone:772-286-1844
Mailing Address - Fax:772-403-6248
Practice Address - Street 1:5650 BRECKENRIDGE PARK DR STE 216
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610-4246
Practice Address - Country:US
Practice Address - Phone:813-284-5499
Practice Address - Fax:724-036-2487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992079251E00000X
FL299992074251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113707900Medicaid
FL114055600Medicaid