=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568544021
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MAYA HOME HEALTH CARE CORP.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2006
-----------------------------------------------------
Last Update Date | 12/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 126 E 49TH ST
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33013-1853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-556-3664
-----------------------------------------------------
Fax | 305-556-3644
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 126 E 49TH ST
-----------------------------------------------------
City | HIALEAH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33013-1853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-556-3664
-----------------------------------------------------
Fax | 305-556-3644
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | MS. LISETT BARRETO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-556-3664
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 10-8347
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------