Provider Demographics
NPI:1124396023
Name:STATE OF ART HOME HEALTH CARE
Entity Type:Organization
Organization Name:STATE OF ART HOME HEALTH CARE
Other - Org Name:STATE OF ART HOME HEALTH CARE
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO,CDO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMION
Authorized Official - Middle Name:ASMOND
Authorized Official - Last Name:MCKENZIE
Authorized Official - Suffix:SR
Authorized Official - Credentials:CFO, CDO
Authorized Official - Phone:954-650-6169
Mailing Address - Street 1:1876 N UNIVERSITY DR STE 308D
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4100
Mailing Address - Country:US
Mailing Address - Phone:954-650-6169
Mailing Address - Fax:954-827-2222
Practice Address - Street 1:1876 N UNIVERSITY DR STE 308D
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4100
Practice Address - Country:US
Practice Address - Phone:954-650-6169
Practice Address - Fax:954-827-2222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211534251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health