Provider Demographics
NPI:1902350226
Name:POINCIANA PERSONAL CARE & COMPANION SERVICES
Entity Type:Organization
Organization Name:POINCIANA PERSONAL CARE & COMPANION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:AB
Authorized Official - Phone:321-437-8888
Mailing Address - Street 1:PO BOX 452878
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34745-2878
Mailing Address - Country:US
Mailing Address - Phone:321-437-8888
Mailing Address - Fax:321-250-7425
Practice Address - Street 1:105 E MONUMENT AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5761
Practice Address - Country:US
Practice Address - Phone:407-350-4138
Practice Address - Fax:321-250-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251J00000X, 3747P1801X
FL253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251J00000XAgenciesNursing CareGroup - Single Specialty
No251E00000XAgenciesHome HealthGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106008100Medicaid