Provider Demographics
NPI:1801342217
Name:AEGIS HOMEMAKING, COMPANION & CHORE SERVICE OF VOLUSIA COUNTY
Entity type:Organization
Organization Name:AEGIS HOMEMAKING, COMPANION & CHORE SERVICE OF VOLUSIA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKERN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-331-3733
Mailing Address - Street 1:357 FOGGY LN
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-7812
Mailing Address - Country:US
Mailing Address - Phone:518-331-3733
Mailing Address - Fax:
Practice Address - Street 1:357 FOGGY LN
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-7812
Practice Address - Country:US
Practice Address - Phone:518-331-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-27
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL234553251E00000X, 251T00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization