1871586503 NPI number — HOME NURSE CORP.

Table of content: GLENN EDGERTON EDD, LAT (NPI 1083149231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871586503 NPI number — HOME NURSE CORP.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOME NURSE 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:
6
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:
1871586503
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10850 SW 113TH PL
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:
33176-3227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-275-2533
Provider Business Mailing Address Fax Number:
305-270-7037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16102 EMERALD ESTATES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33331-6118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-349-4855
Provider Business Practice Location Address Fax Number:
954-332-9344
Provider Enumeration Date:
08/29/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHACON
Authorized Official First Name:
JULIO
Authorized Official Middle Name:
CESAR
Authorized Official Title or Position:
ADMINISTRATOR/GENERAL MANAGER
Authorized Official Telephone Number:
305-275-2533

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HHA299992165 , 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: HHA299992165 . This is a "STATE OF FLORIDA LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".