1376989319 NPI number — AT HOME SENIOR CARE OF BROWARD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376989319 NPI number — AT HOME SENIOR CARE OF BROWARD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AT HOME SENIOR CARE OF BROWARD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376989319
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
725 INTRACOASTAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT LAUDERDALE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33304-3620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-566-8922
Provider Business Mailing Address Fax Number:
954-561-7985

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 INTRACOASTAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT LAUDERDALE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33304-3620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-566-8922
Provider Business Practice Location Address Fax Number:
954-561-7985
Provider Enumeration Date:
05/17/2013

Additional Information

Authorized Official

Authorized Official Last Name:
TIMLIN
Authorized Official First Name:
PHYLLIS
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
954-907-2123

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  30211288 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 006778800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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