Healthcare Provider Details

I. General information

NPI: 1972209716
Provider Name (Legal Business Name): NICMOY HOME CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 09/06/2026
Certification Date: 09/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EAST BOWARD BVLD SUITE 700
FORT LAUDERDALE FL
33301-2642
US

IV. Provider business mailing address

1 EAST BOWARD BVLD SUITE 700
FORT LAUDERDALE FL
33301
US

V. Phone/Fax

Practice location:
  • Phone: 954-745-4966
  • Fax:
Mailing address:
  • Phone: 954-745-4966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: MRS. ILEENE PARKER-SMITH
Title or Position: OWNER
Credential:
Phone: 786-344-1057