Healthcare Provider Details

I. General information

NPI: 1821469362
Provider Name (Legal Business Name): FORTIES STAFFING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2015
Last Update Date: 05/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15390 SW 144TH AVE
MIAMI FL
33177
US

IV. Provider business mailing address

15390 SW 144TH AVE
MIAMI FL
33177-1061
US

V. Phone/Fax

Practice location:
  • Phone: 786-357-0013
  • Fax: 305-859-4253
Mailing address:
  • Phone: 786-357-0013
  • Fax: 305-859-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number234112
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number234112
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number234112
License Number StateFL

VIII. Authorized Official

Name: MRS. MAJELA HERNANDEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 786-357-0013