Provider Demographics
NPI:1679720015
Name:PROFESSIONAL HOME SERVICES OF BROWARD
Entity Type:Organization
Organization Name:PROFESSIONAL HOME SERVICES OF BROWARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECA
Authorized Official - Middle Name:N
Authorized Official - Last Name:GRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:305-469-1819
Mailing Address - Street 1:12741 MIRAMAR PKWY
Mailing Address - Street 2:206
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-2903
Mailing Address - Country:US
Mailing Address - Phone:954-430-8403
Mailing Address - Fax:954-430-8957
Practice Address - Street 1:12741 MIRAMAR PKWY
Practice Address - Street 2:206
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-2905
Practice Address - Country:US
Practice Address - Phone:954-430-8403
Practice Address - Fax:954-430-8957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health