Healthcare Provider Details

I. General information

NPI: 1407470248
Provider Name (Legal Business Name): VENEL SIMON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2020
Last Update Date: 06/13/2020
Certification Date: 06/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

257 S CYPRESS RD APT 418
POMPANO BEACH FL
33060-7032
US

IV. Provider business mailing address

257 S CYPRESS RD APT 418
POMPANO BEACH FL
33060-7032
US

V. Phone/Fax

Practice location:
  • Phone: 561-305-1567
  • Fax:
Mailing address:
  • Phone: 561-305-1567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License NumberCNA305408
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License NumberCNA305408
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License NumberCNA305408
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberCNA305408
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License NumberCNA305408
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberCNA305408
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License NumberCNA305408
License Number StateFL
# 8
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License NumberCNA305408
License Number StateFL
# 9
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberCNA305408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: