Provider Demographics
NPI:1164726162
Name:RNJ HOME HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:RNJ HOME HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:GROSSGLASS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:813-508-5474
Mailing Address - Street 1:47 CAMELOT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8099
Mailing Address - Country:US
Mailing Address - Phone:813-508-5474
Mailing Address - Fax:813-315-9610
Practice Address - Street 1:47 CAMELOT RIDGE DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8099
Practice Address - Country:US
Practice Address - Phone:813-508-5474
Practice Address - Fax:813-315-9610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891450896/891450898Medicaid