Healthcare Provider Details

I. General information

NPI: 1821303470
Provider Name (Legal Business Name): ELOHIM BARA / RAPHA HOME & HOSPITAL FOR THE AGED CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 NW 132ND ST
NORTH MIAMI FL
33168-6625
US

IV. Provider business mailing address

1175 NW 132ND ST
NORTH MIAMI FL
33168-6625
US

V. Phone/Fax

Practice location:
  • Phone: 786-201-0137
  • Fax:
Mailing address:
  • Phone: 786-201-0137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberP222996
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License NumberP222996
License Number StateFL

VIII. Authorized Official

Name: MRS. DJENANE JEAN
Title or Position: PRESIDENT
Credential:
Phone: 786-390-6582