Provider Demographics
NPI:1225548928
Name:HOME SENIOR CARE SERVICES LLC
Entity type:Organization
Organization Name:HOME SENIOR CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WISTON
Authorized Official - Middle Name:
Authorized Official - Last Name:ST JULIEN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:561-860-3094
Mailing Address - Street 1:6501 CONGRESS AVE STE 123
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2840
Mailing Address - Country:US
Mailing Address - Phone:561-860-3094
Mailing Address - Fax:561-634-7438
Practice Address - Street 1:6501 CONGRESS AVE STE 123
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2840
Practice Address - Country:US
Practice Address - Phone:561-860-3094
Practice Address - Fax:561-634-7438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-07
Last Update Date:2017-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL39969280251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health