Provider Demographics
NPI:1073040812
Name:BOYNTON BEACH HOME CARE
Entity Type:Organization
Organization Name:BOYNTON BEACH HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LIDIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:PASKOVA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:561-742-2532
Mailing Address - Street 1:301 E OCEAN AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-3209
Mailing Address - Country:US
Mailing Address - Phone:561-742-2532
Mailing Address - Fax:561-742-2113
Practice Address - Street 1:301 E OCEAN AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-3209
Practice Address - Country:US
Practice Address - Phone:561-742-2532
Practice Address - Fax:561-742-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994358251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health