Provider Demographics
NPI:1013029990
Name:CLINICAL HOME CARE, INC.
Entity Type:Organization
Organization Name:CLINICAL HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:PANEQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-333-0078
Mailing Address - Street 1:11360 FORTUNE CIR
Mailing Address - Street 2:SUITE E29
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8778
Mailing Address - Country:US
Mailing Address - Phone:561-333-0078
Mailing Address - Fax:561-333-0076
Practice Address - Street 1:11360 FORTUNE CIR
Practice Address - Street 2:SUITE E29
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-8721
Practice Address - Country:US
Practice Address - Phone:561-333-0078
Practice Address - Fax:561-333-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1312795332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLR8876OtherBLUE CROSS BLUE SHIELD
FLR8876OtherBLUE CROSS BLUE SHIELD
FL1229800001Medicare NSC