=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194533141
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ODAMAR HOME HEALTH CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/23/2024
-----------------------------------------------------
Last Update Date | 12/23/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5201 BLUE LAGOON DR STE 910
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-2064
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-250-2416
-----------------------------------------------------
Fax | 305-961-1730
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1964 SW 151ST PL
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33185-5692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-250-2416
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARCOS DELGADO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-250-2416
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------