=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023298114
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INSIGNIA HEALTH CARE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2007
-----------------------------------------------------
Last Update Date | 08/07/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7925 NW 12TH ST SUITE #227
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-994-7305
-----------------------------------------------------
Fax | 305-994-7306
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7925 NW 12TH ST SUITE #227
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-994-7305
-----------------------------------------------------
Fax | 305-994-7306
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MERCEDES BLANCO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-994-7305
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 299992901
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------