Provider Demographics
NPI:1952338030
Name:VENICE HMA LLC
Entity Type:Organization
Organization Name:VENICE HMA LLC
Other - Org Name:VENICE REGIONAL BAYFRONT HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLTSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7466
Mailing Address - Street 1:420 TAMIAMI TRL S
Mailing Address - Street 2:SUITE 304
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2620
Mailing Address - Country:US
Mailing Address - Phone:941-486-6718
Mailing Address - Fax:941-486-6709
Practice Address - Street 1:420 TAMIAMI TRL S
Practice Address - Street 2:SUITE 304
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2620
Practice Address - Country:US
Practice Address - Phone:941-486-6718
Practice Address - Fax:941-486-6709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
107404Medicare Oscar/Certification