Organization
JUDAH IN HOME SUPPORT CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CHARMAINE GAYNOR MUIR (MANAGER OWNER)
(772) 203-4762
Entity
Organization
Contact information
Practice address
4812 S FEDERAL HWY # 1, FORT PIERCE, FL 34982-7078
(772) 742-8145
(772) 742-8145
Mailing address
4812 S US HIGHWAY 1, FORT PIERCE, FL 34982-7078
(772) 203-4762
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
017020700
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017020700
—
FL
05
—
018713800
—
FL
Enumeration date
04/18/2017
Last updated
04/18/2017
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