MEDICARE: HOME HEALTH CARE OF THE PALM BEACHES CORP

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457788168
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME HEALTH CARE OF THE PALM BEACHES CORP

Provider Business Mailing Address
First Line	:	4460 CARVER ST
Second Line	:	SIOTE 2
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-2713
Country	:	US
Telephone Number	:	561-248-9784
Fax Number	:

Provider Business Practice Location Address
First Line	:	4460 CARVER ST
Second Line	:	SUITE 2
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-2713
Country	:	US
Telephone Number	:	561-248-9784
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RICARDO MIJARES
Credential	:
Telephone Number	:	561-248-9784

Provider Enumeration Date	:	09/26/2013
Last Update Date	:	09/26/2013

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