=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952963712
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED CARE HOME HEALTH SERVICES, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/02/2019
-----------------------------------------------------
Last Update Date | 07/02/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5881 NW 151ST ST STE 208
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-2456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-615-2160
-----------------------------------------------------
Fax | 786-228-0160
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5881 NW 151ST ST STE 208
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-2456
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-615-2160
-----------------------------------------------------
Fax | 786-228-0160
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DIUSNAIDY DOMINGUEZ HERNANDEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 786-356-0179
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------