Healthcare Provider Details

I. General information

NPI: 1619960341
Provider Name (Legal Business Name): HOME NURSE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2005
Last Update Date: 05/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10850 SW 113TH PL
MIAMI FL
33176-3227
US

IV. Provider business mailing address

10850 SW 113TH PL
MIAMI FL
33176-3227
US

V. Phone/Fax

Practice location:
  • Phone: 305-275-2533
  • Fax: 305-270-7037
Mailing address:
  • Phone: 305-275-2533
  • Fax: 305-270-7037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA299991072
License Number StateFL

VIII. Authorized Official

Name: JULIO CESAR CHACON
Title or Position: ADMINISTRATOR/GENERAL MANAGER
Credential:
Phone: 305-275-2533