Provider Demographics
NPI:1063716975
Name:HOME COMPANIONS OF LAKE CO., INC
Entity type:Organization
Organization Name:HOME COMPANIONS OF LAKE CO., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AVIE
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KEITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-483-3086
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-0148
Mailing Address - Country:US
Mailing Address - Phone:352-483-3086
Mailing Address - Fax:352-483-3136
Practice Address - Street 1:2785 S BAY ST STE D
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6591
Practice Address - Country:US
Practice Address - Phone:352-483-3086
Practice Address - Fax:352-483-3136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992225251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health