Healthcare Provider Details

I. General information

NPI: 1326244245
Provider Name (Legal Business Name): COMPANION HOME CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 09/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1997 SW 17TH CT
MIAMI FL
33145-2707
US

IV. Provider business mailing address

1997 SW 17TH CT
MIAMI FL
33145-2707
US

V. Phone/Fax

Practice location:
  • Phone: 305-854-2631
  • Fax: 305-860-7723
Mailing address:
  • Phone: 305-854-2631
  • Fax: 305-860-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License NumberAL7893
License Number StateFL

VIII. Authorized Official

Name: MRS. MIRIAM C COMPANIONI I
Title or Position: PRESIDENT
Credential: CNA
Phone: 305-854-2631