Provider Demographics
NPI:1902213226
Name:NEVAEH HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:NEVAEH HEALTHCARE SERVICES LLC
Other - Org Name:NEVAEH LIFECARE SERVICES LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:
Authorized Official - First Name:NICKEITA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-629-8712
Mailing Address - Street 1:4615 SW 25TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4305
Mailing Address - Country:US
Mailing Address - Phone:954-629-8712
Mailing Address - Fax:
Practice Address - Street 1:4615 SW 25TH ST
Practice Address - Street 2:
Practice Address - City:WEST PARK
Practice Address - State:FL
Practice Address - Zip Code:33023-4305
Practice Address - Country:US
Practice Address - Phone:954-629-8712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233608251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004149300Medicaid