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General NPI Number Information
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NPI Number | 1902243207
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Entity Type | Organization
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Legal Business Name | SENIOR HOME MAKER COMPANION
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Dates
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Enumeration Date | 05/28/2013
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Last Update Date | 05/28/2013
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Provider Practice Location Address
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Address Line | 13440 SW 36 ST
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City | MIAMI
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State | FL
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Zip | 33175
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Country | US
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Telephone | 786-502-7397
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Fax | 305-559-6572
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Provider Business Mailing Address
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Address Line | 557 E ELCAM CIRCLE SUITE C
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City | MARCO ISLAND
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State | FL
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Zip | 34145
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Country | US
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Telephone | 786-502-7397
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Fax | 305-559-6572
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MS. MARCIA GONGORA
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Credential |
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Telephone | 786-502-7397
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number |
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License Number State | FL
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