Provider Demographics
NPI:1609306521
Name:SISTERS HOME CARE
Entity Type:Organization
Organization Name:SISTERS HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERONA
Authorized Official - Middle Name:ROSEMARIE
Authorized Official - Last Name:JANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-247-5835
Mailing Address - Street 1:11042 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2631
Mailing Address - Country:US
Mailing Address - Phone:954-279-3941
Mailing Address - Fax:
Practice Address - Street 1:1615 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6300
Practice Address - Country:US
Practice Address - Phone:561-247-5835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SISTERS HOME CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-06-13
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5206140164W00000X
L15000142370251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid