1568846756 NPI number — HIS HOUSE, INC.

Table of content: (NPI 1568846756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568846756 NPI number — HIS HOUSE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HIS HOUSE, 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:
1568846756
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20000 NW 47TH AVE
Provider Second Line Business Mailing Address:
HECTOR BUILDING NO. 2
Provider Business Mailing Address City Name:
MIAMI GARDENS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33055-1543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-430-0085
Provider Business Mailing Address Fax Number:
305-474-8533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20000 NW 47TH AVE
Provider Second Line Business Practice Location Address:
HECTOR BUILDING NO. 2
Provider Business Practice Location Address City Name:
MIAMI GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33055-1543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-430-0085
Provider Business Practice Location Address Fax Number:
305-474-8533
Provider Enumeration Date:
07/17/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH-TORRES
Authorized Official First Name:
SILVIA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
305-430-0085

Provider Taxonomy Codes

  • Taxonomy code: 253J00000X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 019399800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 116100500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com