=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669046116
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SINAI HOME HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/19/2021
-----------------------------------------------------
Last Update Date | 05/19/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4851 NW 103RD AVE STE 55E
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-7948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-249-7648
-----------------------------------------------------
Fax | 754-223-7496
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4851 NW 103RD AVE STE 55E
-----------------------------------------------------
City | SUNRISE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33351-7948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-249-7648
-----------------------------------------------------
Fax | 754-223-7496
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | INKA FLETCHER
-----------------------------------------------------
Credential | REGISTERED NURSE
-----------------------------------------------------
Telephone | 954-249-7648
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3747P1801X
-----------------------------------------------------
Taxonomy Name | Personal Care Attendant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------