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General NPI Number Information
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NPI Number | 1770857609
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Entity Type | Organization
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Legal Business Name | HOME DR INC
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 03/12/2017
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Provider Practice Location Address
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Address Line | 1201 E SUNRISE BLVD UNIT 601
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-2880
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Country | US
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Telephone | 787-439-2141
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Fax |
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Provider Business Mailing Address
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Address Line | 1201 E SUNRISE BLVD UNIT 601
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-2880
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Country | US
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Telephone | 787-439-2141
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSE L. RIVERA
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Credential | M.D.
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Telephone | 787-439-2141
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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 |
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License Number State | FL
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