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General NPI Number Information
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NPI Number | 1598925844
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Entity Type | Organization
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Legal Business Name | MEDICOR INC
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Dates
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Enumeration Date | 06/11/2008
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Last Update Date | 10/06/2008
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Provider Practice Location Address
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Address Line | 14213 SW 289TH TER
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City | HOMESTEAD
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State | FL
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Zip | 33033-2989
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Country | US
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Telephone | 305-978-2182
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Fax | 305-246-3344
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Provider Business Mailing Address
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Address Line | 14213 SW 289TH TER
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City | HOMESTEAD
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State | FL
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Zip | 33033-2989
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Country | US
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Telephone | 305-978-2182
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Fax | 305-246-3344
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Authorized Official
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Title or Position | PRESIDENT
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Name | JUAN CARLOS SANTANA
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Credential |
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Telephone | 305-978-2182
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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 | ARNP9214359
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License Number State | FL
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