=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043789977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED HEALTH HOME CARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2018
-----------------------------------------------------
Last Update Date | 11/20/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1827 W HILLSBORO BLVD
-----------------------------------------------------
City | DEERFIELD BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33442-1442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-900-6695
-----------------------------------------------------
Fax | 954-378-9008
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1827 W HILLSBORO BLVD
-----------------------------------------------------
City | DEERFIELD BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33442-1442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-900-6695
-----------------------------------------------------
Fax | 954-378-9008
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANGER
-----------------------------------------------------
Name | CHRISTINA MOTAY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-993-1302
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------