1316257165 NPI number — MARINA'S HOME HEALTH AGENCY, INC,

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316257165 NPI number — MARINA'S HOME HEALTH AGENCY, INC,

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARINA'S HOME HEALTH AGENCY, 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:
1316257165
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5901 NW 151 STREET
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
MIAMI LAKES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-947-6855
Provider Business Mailing Address Fax Number:
305-357-3306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5901 NW 151 STREET
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
MIAMI LAKES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-947-6855
Provider Business Practice Location Address Fax Number:
305-357-3306
Provider Enumeration Date:
10/14/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LUIS CAMACHO
Authorized Official First Name:
ELISABET
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR/CFO
Authorized Official Telephone Number:
305-947-6855

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)





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