Provider Demographics
NPI:1982880688
Name:FLORIDA SENIOR CARE SERVICES, LLC
Entity Type:Organization
Organization Name:FLORIDA SENIOR CARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP BUSINESS DEVELOPMENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:TACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BA, BS, AAMS
Authorized Official - Phone:772-559-8673
Mailing Address - Street 1:PO BOX 691114
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32969-1114
Mailing Address - Country:US
Mailing Address - Phone:772-559-8673
Mailing Address - Fax:772-564-8719
Practice Address - Street 1:5910 CARRIAGE LAKE CT
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-9476
Practice Address - Country:US
Practice Address - Phone:772-559-8673
Practice Address - Fax:772-564-8719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW6243251B00000X, 251E00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health