Provider Demographics
NPI:1972285526
Name:POINCIANA PERSONAL CARE & COMPANION SERVICES CORP
Entity type:Organization
Organization Name:POINCIANA PERSONAL CARE & COMPANION SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:L
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:407-350-4138
Mailing Address - Street 1:PO BOX 452848
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34745-2848
Mailing Address - Country:US
Mailing Address - Phone:407-350-4138
Mailing Address - Fax:321-250-7463
Practice Address - Street 1:1910 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2902
Practice Address - Country:US
Practice Address - Phone:407-350-4138
Practice Address - Fax:321-250-7463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118544000Medicaid