Healthcare Provider Details

I. General information

NPI: 1770274904
Provider Name (Legal Business Name): RWW HOME AND COMMUNITY REHAB SERVICES FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 07/11/2023
Certification Date: 07/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 WASHINGTON ST STE 402
HOLLYWOOD FL
33021-8287
US

IV. Provider business mailing address

805 N WHITTINGTON PKWY STE 400
LOUISVILLE KY
40222-7102
US

V. Phone/Fax

Practice location:
  • Phone: 786-746-6375
  • Fax:
Mailing address:
  • Phone: 502-560-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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

VIII. Authorized Official

Name: ANGIE MATTINGLY
Title or Position: PROVIDER ENROLLMENT MANAGER
Credential:
Phone: 502-560-2700