Healthcare Provider Details

I. General information

NPI: 1225548928
Provider Name (Legal Business Name): HOME SENIOR CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2017
Last Update Date: 10/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 CONGRESS AVE STE 123
BOCA RATON FL
33487-2840
US

IV. Provider business mailing address

6501 CONGRESS AVE STE 123
BOCA RATON FL
33487-2840
US

V. Phone/Fax

Practice location:
  • Phone: 561-860-3094
  • Fax: 561-634-7438
Mailing address:
  • Phone: 561-860-3094
  • Fax: 561-634-7438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number39969280
License Number StateFL

VIII. Authorized Official

Name: MR. WISTON ST JULIEN
Title or Position: ADMINISTRATOR
Credential: MHA
Phone: 561-860-3094