Healthcare Provider Details

I. General information

NPI: 1164584579
Provider Name (Legal Business Name): HOME BOUND CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NW 183RD ST
MIAMI FL
33169-4464
US

IV. Provider business mailing address

340 NW 183RD ST
MIAMI FL
33169-4464
US

V. Phone/Fax

Practice location:
  • Phone: 305-652-3100
  • Fax: 305-652-1290
Mailing address:
  • Phone: 305-652-3100
  • Fax: 305-652-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberHHA21994096
License Number StateFL

VIII. Authorized Official

Name: KATHLEEN EVANINA
Title or Position: CEO
Credential: CRNP
Phone: 570-233-0602