1275284069 NPI number — UNICARE HOME HEALTH SERVICES LLC

Table of content: (NPI 1275284069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275284069 NPI number — UNICARE HOME HEALTH SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNICARE HOME HEALTH SERVICES 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:
Provider Other Organization Name Type Code:
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:
1275284069
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5272 KRENSON WOODS WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33813-6601
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-812-0417
Provider Business Mailing Address Fax Number:
863-603-3291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 LAKE WIRE DR STE 185
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33815-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-812-0417
Provider Business Practice Location Address Fax Number:
863-603-3291
Provider Enumeration Date:
01/12/2022

Additional Information

Authorized Official

Authorized Official Last Name:
CABRERA CASTELLANOS
Authorized Official First Name:
DANIELA
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
813-812-0417

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: 115533600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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