Provider Demographics
NPI:1003283375
Name:ABC HOME CARE FACILITY, LLC
Entity Type:Organization
Organization Name:ABC HOME CARE FACILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:561-317-4752
Mailing Address - Street 1:301 MULBERRY GROVE RD
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-4500
Mailing Address - Country:US
Mailing Address - Phone:561-317-4752
Mailing Address - Fax:561-795-7391
Practice Address - Street 1:301 MULBERRY GROVE RD
Practice Address - Street 2:
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-4500
Practice Address - Country:US
Practice Address - Phone:561-317-4752
Practice Address - Fax:561-795-7391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-21
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9184296163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL599077Medicaid