Provider Demographics
NPI:1184934895
Name:EDITH BERRIEN HOMEHEALTH SERVICE
Entity type:Organization
Organization Name:EDITH BERRIEN HOMEHEALTH SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:STEPHENS
Authorized Official - Last Name:BERRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:HOMEHEALTH
Authorized Official - Phone:813-508-4923
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:6011 VEL STREET
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598
Mailing Address - Country:US
Mailing Address - Phone:813-508-4923
Mailing Address - Fax:813-634-5200
Practice Address - Street 1:6011 VEL STREET
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598
Practice Address - Country:US
Practice Address - Phone:813-508-4923
Practice Address - Fax:813-634-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2340450000251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health