Provider Demographics
NPI:1235637521
Name:WORTHINGTON HOMEE LLC
Entity Type:Organization
Organization Name:WORTHINGTON HOMEE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SASHA KAY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-577-2459
Mailing Address - Street 1:1633 16TH LN
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4360
Mailing Address - Country:US
Mailing Address - Phone:561-577-2459
Mailing Address - Fax:561-965-8024
Practice Address - Street 1:1633 16TH LN
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-4360
Practice Address - Country:US
Practice Address - Phone:561-577-2459
Practice Address - Fax:561-965-8024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2018-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL091943261QD1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities