Provider Demographics
NPI:1699545160
Name:PRIVATE DUTY HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:PRIVATE DUTY HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CFO
Authorized Official - Prefix:
Authorized Official - First Name:HASSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADEHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-472-6289
Mailing Address - Street 1:2500 NW 79TH AVE STE 165
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1082
Mailing Address - Country:US
Mailing Address - Phone:786-472-6289
Mailing Address - Fax:786-522-4376
Practice Address - Street 1:2500 NW 79TH AVE STE 165
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1082
Practice Address - Country:US
Practice Address - Phone:786-472-6289
Practice Address - Fax:786-522-4376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care