Provider Demographics
NPI:1760576664
Name:PHYSICIAN CHOICE HOME HEALTH SERVICES
Entity Type:Organization
Organization Name:PHYSICIAN CHOICE HOME HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CASELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-946-1920
Mailing Address - Street 1:1129 US HIGHWAY 1 STE 1
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2713
Mailing Address - Country:US
Mailing Address - Phone:321-683-8640
Mailing Address - Fax:321-609-9059
Practice Address - Street 1:41 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-4304
Practice Address - Country:US
Practice Address - Phone:954-946-1920
Practice Address - Fax:954-946-8338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108343Medicare ID - Type Unspecified