MEDICARE: PERSONAL CHOICE HOME HEALTH SERVICES,INC

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	251E00000X	Home Health Agency	HHA216070961	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HHA216070961	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1164489902
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONAL CHOICE HOME HEALTH SERVICES,INC

Provider Business Mailing Address
First Line	:	41 N FEDERAL HWY
Second Line	:
City	:	POMPANO BEACH
State	:	FL
Zip	:	33062-4304
Country	:	US
Telephone Number	:	954-946-1920
Fax Number	:	954-946-8338

Provider Business Practice Location Address
First Line	:	2502 QUINCY AVE STE 101
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34947-4766
Country	:	US
Telephone Number	:	772-468-8686
Fax Number	:	772-468-5958

Authorized Official
Title or Position	:	OWNER
Name	:	MR. VIJAY GUPTA
Credential	:
Telephone Number	:	954-946-1920

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	11/29/2017

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