NPIMap

Organization Active NPI

Professional Home Health Services LLC

  • Home Health Agency
  • North Miami Beach, FL
National Provider Identifier
1104470228
Registry record updated Feb 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
PROFESSIONAL HOME HEALTH SERVICES LLC
Practice address
1990 NE 163Rd St Ste 102
North Miami Beach, FL 33162-4854
Phone
(305) 690-7436
Fax
(877) 872-4314
NPI assigned
Jul 26, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mariya Manzon
Title
President
Phone
(305) 952-4601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

1990 NE 163Rd St Ste 102
North Miami Beach, FL 33162-4854

Mailing address

1990 NE 163Rd St Ste 102
North Miami Beach, FL 33162-4854
Phone (305) 690-7436

Other practice location 1

6067 Hollywood Blvd Ste 202
Hollywood, FL 33024-7922
Phone (754) 201-2254

Other identifiers 1

IdentifierTypeStateIssuer
106066500MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200511003371 FL Part A Provider - Home Health Agency 7012348808 Practice locations: North Miami Beach, FL
O20201022003934 FL Part A Provider - Home Health Agency 7012348808 Practice locations: Hallandale Beach, FL

Home health agency certification: CCN 687048

Legal name
PROFESSIONAL HOME HEALTH SERVICES LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 30, 2020
Last certification
Jul 30, 2020
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
in FL
Enrollment address
1990 NE 163Rd St
Ste 102
North Miami Beach, FL 33162-4854

Home health agency certification: CCN 687093

Legal name
PROFESSIONAL HOME HEALTH SERVICES LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Feb 24, 2021
Last certification
Feb 24, 2021
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Jun 12, 2019 in FL
Enrollment address
1801 S Ocean Dr
Ste I
Hallandale Beach, FL 33009-4931

Care Compare: Home health agency

Medicare Care Compare
Listed as
Professional Home Health Services LLCCCN 687093
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Feb 24, 2021
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Occupational therapy

Care Compare: Home health agency

Medicare Care Compare
Listed as
Professional Home Health Services LLCCCN 687048
Overall star rating
3.5 of 5
Ownership
Proprietary
Certified
Jul 30, 2020
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Occupational therapy

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2174049Professional Home Health Services LLC1990 NE 163Rd St Ste 102, North Miami Beach, FL 33162Certificate of waiverOct 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Professional Home Health Services LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1990 NE 163rd St
Ste 102
North Miami Beach, FL 33162
Phone (305) 945-9906

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mariya Manzon Individual 5% Or Greater Direct Ownership Interest Nov 16, 2021 100%
Operational/Managerial ControlManager Nov 16, 2021 100%
Inna Guseva Individual W-2 Managing EmployeeAd; Jul 7, 2023
Iryna Chuieva Individual W-2 Managing EmployeeAd; Jun 30, 2024 100%

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 13

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1564099200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614297600000",
    "number": "1104470228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1990 NE 163RD ST STE 102",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331624854",
            "telephone_number": "305-690-7436",
            "fax_number": "877-872-4314"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1990 NE 163RD ST STE 102",
            "city": "NORTH MIAMI BEACH",
            "state": "FL",
            "postal_code": "331624854",
            "telephone_number": "305-690-7436",
            "fax_number": "877-872-4314"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6067 Hollywood Blvd Ste 202",
            "address_purpose": "LOCATION",
            "city": "Hollywood",
            "state": "FL",
            "postal_code": "330247922",
            "country_code": "US",
            "telephone_number": "754-201-2254",
            "fax_number": "877-872-4314",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROFESSIONAL HOME HEALTH SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-26",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A",
        "authorized_official_last_name": "MANZON",
        "authorized_official_first_name": "MARIYA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "305-952-4601"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "106066500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Miami Beach, FL

Sources for this page

Verify at the official NPI Registry.