Provider Demographics
NPI:1871893461
Name:AGING IN THE COMFORT OF HOME, FT LAUDERDALE NORTH/WEST PALM BEACH, LLC
Entity type:Organization
Organization Name:AGING IN THE COMFORT OF HOME, FT LAUDERDALE NORTH/WEST PALM BEACH, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-687-7583
Mailing Address - Street 1:1350 NE 50TH CT
Mailing Address - Street 2:#404
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4957
Mailing Address - Country:US
Mailing Address - Phone:954-687-7583
Mailing Address - Fax:
Practice Address - Street 1:1350 NE 50TH CT
Practice Address - Street 2:#404
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33334-4957
Practice Address - Country:US
Practice Address - Phone:954-687-7583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL253Z00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies