Healthcare Provider Details

I. General information

NPI: 1942456843
Provider Name (Legal Business Name): SAN RAFAEL HOME HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2008
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13373 SW 283RD ST
HOMESTEAD FL
33033-7381
US

IV. Provider business mailing address

17961 SW 143RD CT
MIAMI FL
33177-7664
US

V. Phone/Fax

Practice location:
  • Phone: 305-246-2220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL 11080
License Number StateFL

VIII. Authorized Official

Name: ADA F. PEREZ
Title or Position: PRESIDENT/DIRECTOR
Credential: LIC.
Phone: 305-235-1752