Provider Demographics
NPI:1558818138
Name:DOUGLAS GARDENS HOME CARE, INC.
Entity Type:Organization
Organization Name:DOUGLAS GARDENS HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE REGISTRY ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILCA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-762-3880
Mailing Address - Street 1:705 SW 88 AVE
Mailing Address - Street 2:DOUGLAS GARDENS HOME CARE
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025
Mailing Address - Country:US
Mailing Address - Phone:954-441-7032
Mailing Address - Fax:305-675-4687
Practice Address - Street 1:705 SW 88 AVE
Practice Address - Street 2:DOUGLAS GARDENS HOME CARE
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025
Practice Address - Country:US
Practice Address - Phone:954-441-7032
Practice Address - Fax:305-675-4687
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:-
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-01
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30211838251E00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114246200Medicaid