Provider Demographics
NPI:1871168047
Name:SENIOR CARE OF CLEARWATER LLC
Entity type:Organization
Organization Name:SENIOR CARE OF CLEARWATER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIVUK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-401-4700
Mailing Address - Street 1:18933 CHAVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-2871
Mailing Address - Country:US
Mailing Address - Phone:727-401-4700
Mailing Address - Fax:727-498-2046
Practice Address - Street 1:5601 AIRPORT BLVD STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5305
Practice Address - Country:US
Practice Address - Phone:727-401-4700
Practice Address - Fax:727-498-2046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health