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General NPI Number Information
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NPI Number | 1821303470
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Entity Type | Organization
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Legal Business Name | ELOHIM BARA / RAPHA HOME & HOSPITAL FOR THE AGED CORP
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Dates
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Enumeration Date | 08/06/2010
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Last Update Date | 08/06/2010
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Provider Practice Location Address
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Address Line | 1175 NW 132ND ST
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City | NORTH MIAMI
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State | FL
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Zip | 33168-6625
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Country | US
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Telephone | 786-201-0137
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Fax |
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Provider Business Mailing Address
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Address Line | 1175 NW 132ND ST
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City | NORTH MIAMI
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State | FL
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Zip | 33168-6625
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Country | US
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Telephone | 786-201-0137
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. DJENANE JEAN
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Credential |
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Telephone | 786-390-6582
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | P222996
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | P222996
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License Number State | FL
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