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?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004437200Medicaid
FL004437200Medicaid