Provider Demographics
NPI:1356063598
Name:WINNER HEALTHCARE LLC
Entity type:Organization
Organization Name:WINNER HEALTHCARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-681-8193
Mailing Address - Street 1:712 S OCEAN SHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:FLAGLER BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32136-3602
Mailing Address - Country:US
Mailing Address - Phone:386-871-1975
Mailing Address - Fax:386-800-2929
Practice Address - Street 1:712 S OCEAN SHORE BLVD
Practice Address - Street 2:
Practice Address - City:FLAGLER BEACH
Practice Address - State:FL
Practice Address - Zip Code:32136-3602
Practice Address - Country:US
Practice Address - Phone:386-871-1975
Practice Address - Fax:386-800-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-14
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL119132700Medicaid
FLFL197OtherN/A