Provider Demographics
NPI:1851586317
Name:PALM COAST HEALTH CARE INC
Entity Type:Organization
Organization Name:PALM COAST HEALTH CARE INC
Other - Org Name:BROOKDALE HOME HEALTH BROWARD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-221-2250
Mailing Address - Street 1:111 WESTWOOD PL
Mailing Address - Street 2:STE 400
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5021
Mailing Address - Country:US
Mailing Address - Phone:615-221-2250
Mailing Address - Fax:615-221-2280
Practice Address - Street 1:1451 W CYPRESS CREEK RD
Practice Address - Street 2:STE 300
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-1961
Practice Address - Country:US
Practice Address - Phone:954-334-5852
Practice Address - Fax:954-334-5810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20135096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108066Medicare Oscar/Certification