1306861208 NPI number — ALL FLORIDA HOME HEALTH SERVICES, INC

Table of content: (NPI 1306861208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306861208 NPI number — ALL FLORIDA HOME HEALTH SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALL FLORIDA HOME HEALTH SERVICES, 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:
1306861208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
08/23/2018
NPI Reactivation Date:
09/05/2018

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4601 NW 77TH AVENUE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-845-8585
Provider Business Mailing Address Fax Number:
786-845-8586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4601 NW 77TH AVENUE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-263-9992
Provider Business Practice Location Address Fax Number:
786-845-8586
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
MERCEDES
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
305-263-9992

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 299992599 . This is a "AHCA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 455105 . This is a "THE JOINT COMMISSION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 800021974 . This is a "CLIA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 102183600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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