=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851513998
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GRANNY'S HOME HEALTH CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2007
-----------------------------------------------------
Last Update Date | 10/23/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8323 NW 12TH ST SUITE 100
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-1829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-887-1123
-----------------------------------------------------
Fax | 305-559-6043
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8323 NW 12TH ST SUITE 100
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33126-1829
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-887-1123
-----------------------------------------------------
Fax | 305-559-6043
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE-PRESIDENT
-----------------------------------------------------
Name | EDUARDO GUERRA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-887-1123
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 299992743
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------