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General NPI Number Information
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NPI Number | 1164936233
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Entity Type | Organization
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Legal Business Name | DETERMINED CARE HOME HEALTH
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Dates
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Enumeration Date | 11/27/2017
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Last Update Date | 11/27/2017
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Provider Practice Location Address
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Address Line | 648 NE 34TH CT
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City | OAKLAND PARK
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State | FL
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Zip | 33334-2850
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Country | US
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Telephone | 954-245-5129
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Fax | 954-827-2349
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Provider Business Mailing Address
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Address Line | 648 NE 34TH CT
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City | OAKLAND PARK
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State | FL
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Zip | 33334-2850
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Country | US
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Telephone | 954-245-5129
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Fax | 954-827-2349
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Authorized Official
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Title or Position | OWNER
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Name | PHACHLE ALTIDOR
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Credential | LPN
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Telephone | 954-245-5129
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | PN5211091
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License Number State | FL
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