=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487202461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | QUALITY HOME CARE OF SOUTH FLORIDA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2019
-----------------------------------------------------
Last Update Date | 09/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10420 SW 77TH AVE STE 101A
-----------------------------------------------------
City | PINECREST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-3771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-877-4348
-----------------------------------------------------
Fax | 813-336-4171
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10420 SW 77TH AVE STE 101A
-----------------------------------------------------
City | PINECREST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33156-3771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-877-4348
-----------------------------------------------------
Fax | 813-336-4171
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER/OWNER
-----------------------------------------------------
Name | MS. MARITZA LOPEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-877-4348
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------