Provider Demographics
NPI:1821167503
Name:QUALIFIED PROFESSIONAL HOME HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:QUALIFIED PROFESSIONAL HOME HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:L
Authorized Official - Last Name:ORTEA
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN
Authorized Official - Phone:305-807-9372
Mailing Address - Street 1:801 W ANN ARBOR TRAIL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1694
Mailing Address - Country:US
Mailing Address - Phone:734-414-9990
Mailing Address - Fax:775-258-1535
Practice Address - Street 1:5941 NW 173RD DRIVE
Practice Address - Street 2:UNIT B-4
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5110
Practice Address - Country:US
Practice Address - Phone:305-807-9372
Practice Address - Fax:775-330-9142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992564251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109070Medicare Oscar/Certification