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General NPI Number Information
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NPI Number | 1194240150
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Entity Type | Organization
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Legal Business Name | PRIVATE HOME CARE LLC
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Dates
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Enumeration Date | 08/10/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5211 CELERY LN
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418
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Country | US
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Telephone | 561-660-2089
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Fax |
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Provider Business Mailing Address
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Address Line | 5211 CELERY LN
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-3511
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Country | US
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Telephone | 561-660-2089
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Fax |
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | MRS. WINNIFRED DAVIS
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Credential |
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Telephone | 561-660-2089
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 234926
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 385H00000X
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Taxonomy Name | Respite Care
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number |
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License Number State |
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