Provider Demographics
NPI:1497593818
Name:COMPLETE CARE AT HOME - NORTH FLORIDA, LLC.
Entity type:Organization
Organization Name:COMPLETE CARE AT HOME - NORTH FLORIDA, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:AIJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:805-452-6688
Mailing Address - Street 1:515 PALM COAST PKWY SW
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4739
Mailing Address - Country:US
Mailing Address - Phone:386-271-2737
Mailing Address - Fax:
Practice Address - Street 1:515 PALM COAST PKWY SW
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4739
Practice Address - Country:US
Practice Address - Phone:386-271-2737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care