Healthcare Provider Details

I. General information

NPI: 1710821970
Provider Name (Legal Business Name): A SIGNATURE LIVING PERSONALIZED CARE AT HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/17/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2598 E SUNRISE BLVD STE 2104
FORT LAUDERDALE FL
33304-3230
US

IV. Provider business mailing address

2598 E SUNRISE BLVD STE 2104
FORT LAUDERDALE FL
33304-3230
US

V. Phone/Fax

Practice location:
  • Phone: 770-843-7188
  • Fax:
Mailing address:
  • Phone: 770-843-7188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: PAULAMAE DELORIS HARRIS
Title or Position: MANAGING MEMBER
Credential: RN
Phone: 770-843-7188