Provider Demographics
NPI:1962998021
Name:SOUTH FLORIDA HOME MODIFICATION LLC
Entity type:Organization
Organization Name:SOUTH FLORIDA HOME MODIFICATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR/MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-660-4480
Mailing Address - Street 1:931 VILLAGE BLVD STE 905-417
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1803
Mailing Address - Country:US
Mailing Address - Phone:561-660-4480
Mailing Address - Fax:
Practice Address - Street 1:931 VILLAGE BLVD STE 905-417
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1803
Practice Address - Country:US
Practice Address - Phone:561-660-4480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-02
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WH0202XOther Service ProvidersContractorHome ModificationsGroup - Multi-Specialty