Healthcare Provider Details

I. General information

NPI: 1295912129
Provider Name (Legal Business Name): LIRA HOME CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 EVERETT AVE
SPRING HILL FL
34609-2447
US

IV. Provider business mailing address

4125 EVERETT AVE
SPRING HILL FL
34609-2447
US

V. Phone/Fax

Practice location:
  • Phone: 352-683-9784
  • Fax: 352-683-9784
Mailing address:
  • Phone: 352-683-9784
  • Fax: 352-683-9784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number6906179
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number6906179
License Number StateFL

VIII. Authorized Official

Name: MRS. IRINA P KATSENKO
Title or Position: PRESIDENT
Credential:
Phone: 352-232-1986