Provider Demographics
NPI:1801232749
Name:JENNIFER'S HOME CARE
Entity Type:Organization
Organization Name:JENNIFER'S HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:IVALINE
Authorized Official - Last Name:GAYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-709-4497
Mailing Address - Street 1:7100 NW 76TH DR
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-5181
Mailing Address - Country:US
Mailing Address - Phone:954-709-4497
Mailing Address - Fax:954-597-1567
Practice Address - Street 1:7100 NW 76TH DR
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-5181
Practice Address - Country:US
Practice Address - Phone:954-709-4497
Practice Address - Fax:954-597-1567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-19
Last Update Date:2013-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10572261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care