Provider Demographics
NPI:1720317332
Name:CONSUELLO PICKARD
Entity type:Organization
Organization Name:CONSUELLO PICKARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CONSUELLO
Authorized Official - Middle Name:
Authorized Official - Last Name:PICKARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-348-6924
Mailing Address - Street 1:901 MCCORMACK ST
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-4233
Mailing Address - Country:US
Mailing Address - Phone:352-348-6924
Mailing Address - Fax:
Practice Address - Street 1:901 MCCORMACK ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-4233
Practice Address - Country:US
Practice Address - Phone:352-348-6924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-09
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCS231217253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care