Provider Demographics
NPI:1992329320
Name:VISITING HEALTH SERVICES OF SOUTH FLORIDA
Entity type:Organization
Organization Name:VISITING HEALTH SERVICES OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALYSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:754-777-0797
Mailing Address - Street 1:1190 NW 166TH AVE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1341
Mailing Address - Country:US
Mailing Address - Phone:754-777-0794
Mailing Address - Fax:
Practice Address - Street 1:1190 NW 166TH AVE
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1341
Practice Address - Country:US
Practice Address - Phone:754-777-0794
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-01
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center