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General NPI Number Information
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NPI Number | 1013029990
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Entity Type | Organization
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Legal Business Name | CLINICAL HOME CARE, INC.
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 11360 FORTUNE CIR SUITE E29
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City | WELLINGTON
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State | FL
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Zip | 33414-8721
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Country | US
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Telephone | 561-333-0078
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Fax | 561-333-0076
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Provider Business Mailing Address
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Address Line | 11360 FORTUNE CIR SUITE E29
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City | WELLINGTON
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State | FL
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Zip | 33414-8778
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Country | US
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Telephone | 561-333-0078
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Fax | 561-333-0076
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Authorized Official
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Title or Position | PRES OWNER
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Name | MR. ROBERT A PANEQUE
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Credential |
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Telephone | 561-333-0078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 1312795
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License Number State | FL
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