Provider Demographics
NPI:1700847357
Name:NEU HEART EXTENDED HOMECARE SERVICES
Entity Type:Organization
Organization Name:NEU HEART EXTENDED HOMECARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-724-7778
Mailing Address - Street 1:P.O. BOX 190459
Mailing Address - Street 2:7173 WEST OAKLAND PARK BLVD
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33313
Mailing Address - Country:US
Mailing Address - Phone:954-724-7778
Mailing Address - Fax:954-724-7107
Practice Address - Street 1:7173 WEST OAKLAND PARK BLVD.
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33313
Practice Address - Country:US
Practice Address - Phone:954-724-7778
Practice Address - Fax:954-724-7107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA29991658251E00000X
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299991553OtherAACA LICENSE
FL682907400Medicaid