Provider Demographics
NPI:1831200948
Name:XL CARE AGENCY, INC. OF COLLIER
Entity type:Organization
Organization Name:XL CARE AGENCY, INC. OF COLLIER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-257-4285
Mailing Address - Street 1:885 PENNIMAN AVE UNIT 6426
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-7722
Mailing Address - Country:US
Mailing Address - Phone:888-891-0786
Mailing Address - Fax:
Practice Address - Street 1:389 COMMERCIAL CT STE A
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1617
Practice Address - Country:US
Practice Address - Phone:941-787-7606
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991373251E00000X
FL21888096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHC3OtherBLUE CROSS BLUE SHIELD
FLHC3OtherBLUE CROSS BLUE SHIELD