Provider Demographics
NPI:1144560673
Name:MELBEACHOUSE LLC
Entity type:Organization
Organization Name:MELBEACHOUSE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:HELIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-722-2999
Mailing Address - Street 1:1103 W HIBISCUS BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2717
Mailing Address - Country:US
Mailing Address - Phone:321-722-2999
Mailing Address - Fax:321-956-6486
Practice Address - Street 1:1344 S APOLLO BLVD STE 2C
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3183
Practice Address - Country:US
Practice Address - Phone:321-722-2999
Practice Address - Fax:321-586-5372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL232571372600000X, 376J00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty