=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144490855
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | 'A' CLASS HOME HEALTH AGENCY, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/10/2008
-----------------------------------------------------
Last Update Date | 06/04/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3075 W OAKLAND PARK BLVD SUITE 102
-----------------------------------------------------
City | OAKLAND PARK
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33311-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-730-8800
-----------------------------------------------------
Fax | 954-730-8898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 590487
-----------------------------------------------------
City | FT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33359-0487
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-730-8800
-----------------------------------------------------
Fax | 954-730-8898
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MISS SANGAY ELLIOTT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-730-8800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 299992020
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------