1184066094 NPI number — WEST FLORIDA PPHOMEHEALTH, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184066094 NPI number — WEST FLORIDA PPHOMEHEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WEST FLORIDA PPHOMEHEALTH, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ACCOMPLISHED HOME CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184066094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 NE 42ND AVE STE 401
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCALA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34470-8024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-343-1433
Provider Business Mailing Address Fax Number:
727-343-2472

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2915 W CYPRESS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33609-1605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-300-1433
Provider Business Practice Location Address Fax Number:
813-872-8564
Provider Enumeration Date:
07/19/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
YURASKO
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
352-291-6611

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000089100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".