Healthcare Provider Details

I. General information

NPI: 1316101470
Provider Name (Legal Business Name): HYACINTH VIOLA HUTTON PERSONALCARE ASST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 07/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 NW 46TH AVE 114
LAUDERHILL FL
33313-7171
US

IV. Provider business mailing address

1631 NW 46TH AVE APT 114
LAUDERHILL FL
33313-7171
US

V. Phone/Fax

Practice location:
  • Phone: 954-258-1814
  • Fax:
Mailing address:
  • Phone: 954-258-1814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number680229096
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number680229096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: