Provider Demographics
NPI:1689907933
Name:EMERALD HOME HEALTHCARE, INC.
Entity Type:Organization
Organization Name:EMERALD HOME HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AVIS
Authorized Official - Middle Name:SPRADLEY
Authorized Official - Last Name:STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:561-304-4478
Mailing Address - Street 1:3923 LAKE WORTH RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4049
Mailing Address - Country:US
Mailing Address - Phone:561-304-4478
Mailing Address - Fax:561-304-4479
Practice Address - Street 1:3923 LAKE WORTH RD
Practice Address - Street 2:SUITE 112
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4049
Practice Address - Country:US
Practice Address - Phone:561-304-4478
Practice Address - Fax:561-304-4479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-17
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993567251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health