Provider Demographics
NPI:1912599945
Name:SEAHORSE VENTURES, LLC DBA HOMEWELL CARE SERVICES OF MELBOURNE
Entity Type:Organization
Organization Name:SEAHORSE VENTURES, LLC DBA HOMEWELL CARE SERVICES OF MELBOURNE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MASON
Authorized Official - Middle Name:
Authorized Official - Last Name:RISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-303-6018
Mailing Address - Street 1:141 N EAGLE CREEK DR STE 103
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1832
Mailing Address - Country:US
Mailing Address - Phone:859-388-0564
Mailing Address - Fax:
Practice Address - Street 1:141 N EAGLE CREEK DR STE 103
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1832
Practice Address - Country:US
Practice Address - Phone:859-388-0564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care