Provider Demographics
NPI:1053468496
Name:HOME CARE RESOURCES HOME HEALTH AGENCY, LLC
Entity Type:Organization
Organization Name:HOME CARE RESOURCES HOME HEALTH AGENCY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C00
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINOLICH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:561-252-2470
Mailing Address - Street 1:3313 W COMMERCIAL BLVD STE 130
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3413
Mailing Address - Country:US
Mailing Address - Phone:305-895-7052
Mailing Address - Fax:305-895-7054
Practice Address - Street 1:5979 NW 151ST ST STE 234
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2427
Practice Address - Country:US
Practice Address - Phone:305-895-7052
Practice Address - Fax:305-895-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991938251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108265Medicare ID - Type Unspecified