1679901185 NPI number — SHC HOME HEALTH SERVICES - JENSEN BEACH, 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 1679901185 NPI number — SHC HOME HEALTH SERVICES - JENSEN BEACH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHC HOME HEALTH SERVICES - JENSEN BEACH, 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:
6
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:
1679901185
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
759 SW FEDERAL HWY STE 300
Provider Second Line Business Mailing Address:
ROYAL PALM FINANCIAL CENTER BLDG 3
Provider Business Mailing Address City Name:
STUART
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34994-2923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
772-287-5111
Provider Business Mailing Address Fax Number:
772-287-5115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
759 SW FEDERAL HWY STE 300
Provider Second Line Business Practice Location Address:
ROYAL PALM FINANCIAL CENTER BLDG 3
Provider Business Practice Location Address City Name:
STUART
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34994-2923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-287-5111
Provider Business Practice Location Address Fax Number:
772-287-5115
Provider Enumeration Date:
10/18/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HARRISON
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
502-568-7800

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)