MEDICARE: CERTIFIED HEALTH CARE SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	21998096	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063503001
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CERTIFIED HEALTH CARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	915 MIDDLE RIVER DRIVE
Second Line	:	SUITE 314
City	:	FT. LAUDERDALE
State	:	FL
Zip	:	33304
Country	:	US
Telephone Number	:	954-677-9500
Fax Number	:	954-677-9200

Provider Business Practice Location Address
First Line	:	3296 N STATE ROAD 7
Second Line	:
City	:	LAUDERDALE LAKES
State	:	FL
Zip	:	33319-5615
Country	:	US
Telephone Number	:	954-677-9500
Fax Number	:	954-677-9200

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	LIDIA KIRITCHENKO
Credential	:
Telephone Number	:	954-677-9500

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	11/23/2016

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