Provider Demographics
NPI:1912768359
Name:PURE INTENTIONS HOME CARE LLC
Entity Type:Organization
Organization Name:PURE INTENTIONS HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARMAINE
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-525-5718
Mailing Address - Street 1:774 ROSA PARKS CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32501-1681
Mailing Address - Country:US
Mailing Address - Phone:850-525-5718
Mailing Address - Fax:
Practice Address - Street 1:774 ROSA PARKS CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32501-1681
Practice Address - Country:US
Practice Address - Phone:850-525-5718
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-22
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health