1093869273 NPI number — ANTAEUS HEALTH SERVICES, CORP.

Table of content: (NPI 1093869273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093869273 NPI number — ANTAEUS HEALTH SERVICES, CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANTAEUS HEALTH SERVICES, CORP.
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:
1093869273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7333 CORAL WAY
Provider Second Line Business Mailing Address:
SUITE 109
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33155-1402
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-500-9697
Provider Business Mailing Address Fax Number:
305-500-9994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7333 CORAL WAY
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33155-1402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-500-9697
Provider Business Practice Location Address Fax Number:
305-500-9994
Provider Enumeration Date:
01/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
RETA
Authorized Official First Name:
MARCOS
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR & OWNER
Authorized Official Telephone Number:
305-500-9697

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA299991821 , 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: HHA299991821 . This is a "HOME HEALTH AGENCY" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 651030200 . This is a "MEDICAID PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10-8058 . This is a "PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com