1821352063 NPI number — HOMEWOOD HOME HEALTH LLC

Table of content: (NPI 1821352063)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821352063 NPI number — HOMEWOOD HOME HEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOMEWOOD HOME HEALTH LLC
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:
1821352063
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6894 LAKE WORTH RD
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
LAKE WORTH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33467-2964
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-275-7500
Provider Business Mailing Address Fax Number:
561-275-7575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6894 LAKE WORTH RD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
LAKE WORTH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33467-2964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-275-7500
Provider Business Practice Location Address Fax Number:
561-275-7575
Provider Enumeration Date:
07/03/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PAREL
Authorized Official First Name:
MATHEW
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
954-973-3800

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  299993841 , 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: 299993841 . This is a "AGENCY FOR HEALTH CARE ADMINISTRATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".