Healthcare Provider Details

I. General information

NPI: 1437823366
Provider Name (Legal Business Name): FLORIDAS HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 08/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 S COPPER ST STE B
DEMING NM
88030-3611
US

IV. Provider business mailing address

204 S COPPER ST STE B
DEMING NM
88030-3611
US

V. Phone/Fax

Practice location:
  • Phone: 575-543-5307
  • Fax: 575-936-4495
Mailing address:
  • Phone: 575-543-5307
  • Fax: 575-936-4495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. RODOLFO TAFOYA
Title or Position: ADMINISTRATION
Credential: OWNER
Phone: 575-543-5307