Provider Demographics
NPI:1992141279
Name:HOME BOUND CARE, INC.
Entity type:Organization
Organization Name:HOME BOUND CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN,C
Authorized Official - Phone:305-652-3100
Mailing Address - Street 1:2331 N STATE ROAD 7
Mailing Address - Street 2:#220
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-3748
Mailing Address - Country:US
Mailing Address - Phone:954-730-3200
Mailing Address - Fax:305-652-1290
Practice Address - Street 1:2331 N STATE ROAD 7
Practice Address - Street 2:#220
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-3748
Practice Address - Country:US
Practice Address - Phone:954-730-3200
Practice Address - Fax:305-652-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299994304251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6871127-01Medicaid