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General NPI Number Information
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NPI Number | 1679720015
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HOME SERVICES OF BROWARD
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Dates
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Enumeration Date | 08/27/2008
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Last Update Date | 08/20/2010
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Provider Practice Location Address
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Address Line | 12741 MIRAMAR PKWY 206
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City | MIRAMAR
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State | FL
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Zip | 33027-2905
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Country | US
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Telephone | 954-430-8403
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Fax | 954-430-8957
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Provider Business Mailing Address
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Address Line | 12741 MIRAMAR PKWY 206
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City | MIRAMAR
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State | FL
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Zip | 33027-2903
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Country | US
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Telephone | 954-430-8403
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Fax | 954-430-8957
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. REBECA N GRILLO
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Credential | R.N., B.S.N.
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Telephone | 305-469-1819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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