Provider Demographics
NPI:1023300860
Name:PRIVATE DUTY HOME HEALTH SERVICES OF THE PALM BEACHES LLC
Entity type:Organization
Organization Name:PRIVATE DUTY HOME HEALTH SERVICES OF THE PALM BEACHES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:YVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DARRISAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-379-5934
Mailing Address - Street 1:12798 FOREST HILL BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4704
Mailing Address - Country:US
Mailing Address - Phone:561-379-5934
Mailing Address - Fax:
Practice Address - Street 1:12798 W FOREST HILL BLVD STE
Practice Address - Street 2:SUITE 303
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4750
Practice Address - Country:US
Practice Address - Phone:561-379-5934
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3689251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health