Provider Demographics
NPI:1609214287
Name:COMPREHENSIVE HOME CARE OF POLK
Entity type:Organization
Organization Name:COMPREHENSIVE HOME CARE OF POLK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-834-2222
Mailing Address - Street 1:6450 NW 5TH WAY
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-6112
Mailing Address - Country:US
Mailing Address - Phone:954-834-2222
Mailing Address - Fax:954-333-9647
Practice Address - Street 1:373 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3047
Practice Address - Country:US
Practice Address - Phone:863-594-1031
Practice Address - Fax:863-582-9778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE HOME CARE OF HILLSBOROUGH LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991972251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108136Medicare Oscar/Certification