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General NPI Number Information
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NPI Number | 1891981072
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Entity Type | Organization
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Legal Business Name | WIDE HEALTH CARE CORPORATION
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Dates
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Enumeration Date | 09/20/2007
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Last Update Date | 10/28/2009
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Provider Practice Location Address
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Address Line | 7171 CORAL WAY STE 310
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City | MIAMI
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State | FL
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Zip | 33155-1694
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Country | US
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Telephone | 305-269-9808
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Fax | 306-269-1649
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Provider Business Mailing Address
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Address Line | 7171 CORAL WAY STE 310
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City | MIAMI
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State | FL
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Zip | 33155-1694
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Country | US
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Telephone | 305-269-9808
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Fax | 306-269-1649
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSE A TILLAN
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Credential |
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Telephone | 305-269-9808
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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 |
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