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General NPI Number Information
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NPI Number | 1124396023
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Entity Type | Organization
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Legal Business Name | STATE OF ART HOME HEALTH CARE
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Dates
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Enumeration Date | 12/06/2011
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 1876 N UNIVERSITY DR STE 308D
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City | PLANTATION
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State | FL
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Zip | 33322-4100
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Country | US
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Telephone | 954-650-6169
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Fax | 954-827-2222
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Provider Business Mailing Address
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Address Line | 1876 N UNIVERSITY DR STE 308D
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City | PLANTATION
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State | FL
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Zip | 33322-4100
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Country | US
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Telephone | 954-650-6169
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Fax | 954-827-2222
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Authorized Official
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Title or Position | CFO,CDO
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Name | MR. DAMION ASMOND MCKENZIE SR.
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Credential | CFO, CDO
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Telephone | 954-650-6169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 30211534
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License Number State | FL
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