Provider Demographics
NPI:1598116303
Name:PAX HOME CARE LLC
Entity type:Organization
Organization Name:PAX HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFERSON
Authorized Official - Middle Name:
Authorized Official - Last Name:JUERAKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-447-3921
Mailing Address - Street 1:3890 E STATE ROAD 64
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34208-9040
Mailing Address - Country:US
Mailing Address - Phone:941-447-3921
Mailing Address - Fax:
Practice Address - Street 1:3890 E STATE ROAD 64
Practice Address - Street 2:SUITE 104
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-9040
Practice Address - Country:US
Practice Address - Phone:941-447-3921
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health