Healthcare Provider Details

I. General information

NPI: 1881820512
Provider Name (Legal Business Name): ANNETTE M. WELLINGTON-HALL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 05/27/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5830 SHERIDAN STREET
HOLLYWOOD FL
33021
US

IV. Provider business mailing address

5830 SHERIDAN STREET
HOLLYWOOD FL
33021
US

V. Phone/Fax

Practice location:
  • Phone: 954-437-9880
  • Fax: 954-437-9881
Mailing address:
  • Phone: 954-437-9880
  • Fax: 954-437-9881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number299993762
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number299993762
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number10D2012729
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number230571
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number299993762
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 9
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number29993762
License Number StateFL
# 10
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number29993762
License Number StateFL

VIII. Authorized Official

Name: ANNETTE M WELLINGTON
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 954-437-9880