=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639303688
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | U.S. HOME HEALTH CARE SERVICES, CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/06/2009
-----------------------------------------------------
Last Update Date | 05/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14440 US HIGHWAY 27
-----------------------------------------------------
City | LAKE WALES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33859-2546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-638-3820
-----------------------------------------------------
Fax | 863-678-1900
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14440 US HIGHWAY 27
-----------------------------------------------------
City | LAKE WALES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33859-2546
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-638-3820
-----------------------------------------------------
Fax | 863-678-1900
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. JAIDY JIMENEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 863-638-3820
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------