Provider Demographics
NPI: | 1003194697 |
---|---|
Name: | HOME HEALTH CARE OF FLORIDA |
Entity Type: | Organization |
Organization Name: | HOME HEALTH CARE OF FLORIDA |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | GEOFFREY |
Authorized Official - Middle Name: | R |
Authorized Official - Last Name: | FRASER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 321-288-0171 |
Mailing Address - Street 1: | 4501 N. WICKHAM ROAD |
Mailing Address - Street 2: | SUITE 103 |
Mailing Address - City: | MELBOURNE |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32935 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 321-610-3983 |
Mailing Address - Fax: | 321-610-3984 |
Practice Address - Street 1: | 4501 N. WICKHAM ROAD |
Practice Address - Street 2: | SUITE 103 |
Practice Address - City: | MELBOURNE |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32935 |
Practice Address - Country: | US |
Practice Address - Phone: | 321-610-3983 |
Practice Address - Fax: | 321-610-3984 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-07-29 |
Last Update Date: | 2017-05-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 251E00000X | Agencies | Home Health |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 004437200 | Medicaid | |
FL | 004437200 | Medicaid |