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General NPI Number Information
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NPI Number | 1215226857
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Entity Type | Organization
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Legal Business Name | THIS IS YOUR HOME SERVICES, LLC
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Dates
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Enumeration Date | 04/05/2011
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 2581 W APRICOT DR
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City | BEVERLY HILLS
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State | FL
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Zip | 34465-3054
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Country | US
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Telephone | 352-257-3079
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Fax | 352-527-8222
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Provider Business Mailing Address
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Address Line | PO BOX 640819
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City | BEVERLY HILLS
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State | FL
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Zip | 34464-3054
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Country | US
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Telephone | 352-257-3079
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Fax | 352-527-8222
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSE A AREVALO
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Credential |
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Telephone | 352-257-3079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number | 003061800
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License Number State | FL
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