1700443926 NPI number — SISTERS HOME CARE SERVICES, INC.

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 1700443926 NPI number — SISTERS HOME CARE SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SISTERS HOME CARE SERVICES, INC.
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:
1700443926
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4010 HIGHGATE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VALRICO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33594-5310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-654-2329
Provider Business Mailing Address Fax Number:
800-654-7519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
409 BLOOMINGFIELD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANDON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33511-7984
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-654-2329
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2019

Additional Information

Authorized Official

Authorized Official Last Name:
DERIVEAU
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
813-654-2329

Provider Taxonomy Codes

  • Taxonomy code: 311ZA0620X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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