=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376892091
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUIDED HEALTH SEVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2012
-----------------------------------------------------
Last Update Date | 09/10/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11247 SW 152ND ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33157-1101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-712-1962
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 971222
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33197-1222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-712-1962
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MS. ANNETTE KING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-712-1962
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number | G12000063551
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------