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General NPI Number Information
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NPI Number | 1487835153
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Entity Type | Organization
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Legal Business Name | RED ROAD HOME HEALTH SERVICE,INC
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 4230 E 4TH AVE
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City | HIALEAH
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State | FL
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Zip | 33013-2306
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Country | US
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Telephone | 305-823-3312
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Fax | 305-823-7932
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Provider Business Mailing Address
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Address Line | 4230 E 4TH AVE
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City | HIALEAH
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State | FL
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Zip | 33013-2306
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Country | US
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Telephone | 305-823-3312
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Fax | 305-823-7932
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Authorized Official
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Title or Position | PRESIDENT
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Name | PROF. JOGE L GONZALEZ
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Credential | RN, CCPA
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Telephone | 786-423-0649
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | RN9247805
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License Number State | FL
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