=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912173857
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADAN HOME HEALTH CARE, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2008
-----------------------------------------------------
Last Update Date | 12/15/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12955 SW 42ND ST SUITE 109
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-2920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-643-0666
-----------------------------------------------------
Fax | 305-646-1320
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12955 SW 42ND ST SUITE 109
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33175-2920
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-643-0666
-----------------------------------------------------
Fax | 305-646-1320
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. WILLIE PEREZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-643-0666
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 299993265
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------