# GREAT CARE PROVIDER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154262731
- **Authorized official:** RAFAEL LAZARO TEJAS MGR (MGR)
- **Authorized official phone:** (954) 908-9022

## Contact information

- **Practice address:** 22468 OLEAN BLVD, PORT CHARLOTTE, FL 33952-5644
- **Practice address phone:** (954) 908-9022
- **Mailing address:** 22468 OLEAN BLVD, PORT CHARLOTTE, FL 33952-5644
- **Mailing address phone:** (954) 908-9022

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | — | NULL | Yes |

## Other

- **Enumeration date:** 04/06/2026
- **Last updated:** 04/06/2026