Provider Demographics
NPI:1053619320
Name:PINELLAS PROFESSIONAL HOME CARE,INC.
Entity type:Organization
Organization Name:PINELLAS PROFESSIONAL HOME CARE,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-418-4198
Mailing Address - Street 1:2075 DUNSTON COVE RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-1316
Mailing Address - Country:US
Mailing Address - Phone:727-418-4198
Mailing Address - Fax:727-467-0923
Practice Address - Street 1:2075 DUNSTON COVE RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-1316
Practice Address - Country:US
Practice Address - Phone:727-418-4198
Practice Address - Fax:727-467-0923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL691579596Medicaid