1376910588 NPI number — MARTHA RIVERA

Table of content: (NPI 1376910588)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376910588 NPI number — MARTHA RIVERA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTHA RIVERA
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:
MIAMI HOME AND COMMUNITY SUPPORT SERVICES INC.
Provider Other Organization Name Type Code:
3
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:
1376910588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6257 SW 150TH PATH
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:
33193-2742
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-543-7677
Provider Business Mailing Address Fax Number:
305-482-6359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6257 SW 150TH PATH
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:
33193-2742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
786-543-7677
Provider Business Practice Location Address Fax Number:
305-482-6359
Provider Enumeration Date:
08/24/2015

Additional Information

Authorized Official

Authorized Official Last Name:
RIVERA
Authorized Official First Name:
MARTHA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
786-543-7677

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  229690 , 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: 689423296 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 229690 . This is a "AHCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 689423298 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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