=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326367681
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATIENT CARE HOME HEALTH SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/26/2010
-----------------------------------------------------
Last Update Date | 10/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1489 W PALMETTO PARK RD SUITE NO 390
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33486-3325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-372-7185
-----------------------------------------------------
Fax | 561-372-7188
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1489 W PALMETTO PARK RD SUITE NO 390
-----------------------------------------------------
City | BOCA RATON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33486-3325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-372-7185
-----------------------------------------------------
Fax | 561-372-7188
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | CARLOS F VALENCIA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-299-0202
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 299993700
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------