MEDICARE: TOP CLASS HOME CARE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency	233327	FL

General Provider Information

NPI Number	:	1023449808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOP CLASS HOME CARE SERVICES

Provider Business Mailing Address
First Line	:	127 NW 4TH AVE
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4115
Country	:	US
Telephone Number	:	305-907-1513
Fax Number	:	305-907-1513

Provider Business Practice Location Address
First Line	:	127 NW 4TH AVE
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-4115
Country	:	US
Telephone Number	:	305-907-1513
Fax Number	:	305-907-1513

Authorized Official
Title or Position	:	OWNER/ADMINISTRATOR
Name	:	RICHARD PETGRAVE
Credential	:
Telephone Number	:	786-859-7265

Provider Enumeration Date	:	12/04/2013
Last Update Date	:	12/04/2013

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