Provider Demographics
NPI:1528360799
Name:PONKEYS HOME CARE
Entity Type:Organization
Organization Name:PONKEYS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:NEDENE
Authorized Official - Last Name:DUFFUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-214-3169
Mailing Address - Street 1:4420 NW 23RD STREET
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313
Mailing Address - Country:US
Mailing Address - Phone:754-214-3169
Mailing Address - Fax:954-306-2314
Practice Address - Street 1:4420 NW 23RD STREET
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33313
Practice Address - Country:US
Practice Address - Phone:754-214-3169
Practice Address - Fax:954-306-2314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691523096Medicaid