1295791887 NPI number — FIRST QUALITY HOME CARE , INC

Table of content: (NPI 1295791887)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295791887 NPI number — FIRST QUALITY HOME CARE , INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST QUALITY HOME CARE , INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1295791887
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9250 W FLAGLER ST STE 510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33174-3415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-223-0150
Provider Business Mailing Address Fax Number:
305-223-0166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9250 W FLAGLER ST STE 510
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33174-3415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-223-0150
Provider Business Practice Location Address Fax Number:
305-223-0166
Provider Enumeration Date:
04/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CUETARA
Authorized Official First Name:
DULCE
Authorized Official Middle Name:
MARIA
Authorized Official Title or Position:
PRESIDENT/CEO/DON
Authorized Official Telephone Number:
305-223-0150

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 21535096 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 015044400 . This is a "LONG TERM COMMUNITY CARE DIVERSION PROGRAM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 674268800 . This is a "MEDICAID MW" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650804900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 674268896 . This is a "DEVELOPMENTAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 684188100 . This is a "MEDICAID ALW" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 650804979 . This is a "BRAIN & SPINAL CORD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 674268802 . This is a "AIDS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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