=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518045988
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRESTIGE HOME CARE SERVICES OF BROWARD, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 06/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2450 HOLLYWOOD BLVD SUITE 102
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-926-2595
-----------------------------------------------------
Fax | 954-926-6742
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2450 HOLLYWOOD BLVD SUITE 102
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-926-2595
-----------------------------------------------------
Fax | 954-926-6742
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. LUIS LIZARAZO
-----------------------------------------------------
Credential | ADMINISTRATOR
-----------------------------------------------------
Telephone | 954-926-2595
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 299992546
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------