MEDICARE: AT TALITHA CUMI HOME CARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	233664	FL
2	3747A0650X	Attendant Care Provider
3	253Z00000X	In Home Supportive Care Agency	233664	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225445190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT TALITHA CUMI HOME CARE, INC

Provider Business Mailing Address
First Line	:	1840 W 49TH ST STE 224
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2949
Country	:	US
Telephone Number	:	786-452-1226
Fax Number	:	786-452-1227

Provider Business Practice Location Address
First Line	:	2328 HANCOCK BRIDGE PKWY STE 112A
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-1455
Country	:	US
Telephone Number	:	786-452-1226
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	YASHIRA M RIVAS
Credential	:
Telephone Number	:	786-454-7021

Provider Enumeration Date	:	07/12/2014
Last Update Date	:	03/15/2023

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