Provider Demographics
NPI:1922018779
Name:BIG LAKE HOME HEALTH SERVICES, INC
Entity Type:Organization
Organization Name:BIG LAKE HOME HEALTH SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SAEED
Authorized Official - Middle Name:A
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MM, CPE
Authorized Official - Phone:863-467-9997
Mailing Address - Street 1:111 NE 11TH ST
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-2118
Mailing Address - Country:US
Mailing Address - Phone:863-467-9997
Mailing Address - Fax:863-467-7322
Practice Address - Street 1:111 NE 11TH ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2118
Practice Address - Country:US
Practice Address - Phone:863-467-9997
Practice Address - Fax:863-467-7322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29991887251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19964481OtherFL HOME HEALTH NUMBER
FL108060Medicare Oscar/Certification