Provider Demographics
NPI:1063503001
Name:CERTIFIED HEALTH CARE SERVICES, INC.
Entity Type:Organization
Organization Name:CERTIFIED HEALTH CARE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRITCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-677-9500
Mailing Address - Street 1:915 MIDDLE RIVER DRIVE
Mailing Address - Street 2:SUITE 314
Mailing Address - City:FT. LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304
Mailing Address - Country:US
Mailing Address - Phone:954-677-9500
Mailing Address - Fax:954-677-9200
Practice Address - Street 1:3296 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319-5615
Practice Address - Country:US
Practice Address - Phone:954-677-9500
Practice Address - Fax:954-677-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21998096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651291700Medicaid
FL2651291700Medicaid
FL687016300Medicaid
108310Medicare ID - Type Unspecified
FL687016300Medicaid