Provider Demographics
NPI:1285382432
Name:STEP UP HOME CARE SERVICES LLC
Entity type:Organization
Organization Name:STEP UP HOME CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:EXCELLENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-672-3829
Mailing Address - Street 1:11341 COCOA BEACH DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-2951
Mailing Address - Country:US
Mailing Address - Phone:813-672-3829
Mailing Address - Fax:
Practice Address - Street 1:11341 COCOA BEACH DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-2951
Practice Address - Country:US
Practice Address - Phone:813-672-3829
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities