Provider Demographics
NPI:1790944288
Name:CERTIFIED HEALTH CARE SERVICES, INC
Entity Type:Organization
Organization Name:CERTIFIED HEALTH CARE SERVICES, INC
Other - Org Name:CERTIFIED HEALTH CARE SERVICES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRITCHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-482-7007
Mailing Address - Street 1:ONE SOUTH OCEAN BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434
Mailing Address - Country:US
Mailing Address - Phone:561-482-7007
Mailing Address - Fax:954-482-7717
Practice Address - Street 1:23006 SANDALFOOT PLAZA DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428
Practice Address - Country:US
Practice Address - Phone:561-482-7007
Practice Address - Fax:954-482-7717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991316251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006243600Medicaid
FL006243600Medicaid