MEDICARE: VIDA 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	310400000X	Assisted Living Facility	AL10335	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	:	1285130971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIDA HOME CARE INC

Provider Business Mailing Address
First Line	:	9099 NW 113TH ST
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4561
Country	:	US
Telephone Number	:	305-828-0395
Fax Number	:

Provider Business Practice Location Address
First Line	:	9099 NW 113TH ST
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33018-4561
Country	:	US
Telephone Number	:	305-828-0395
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MAIKEL RODRIGUEZ
Credential	:
Telephone Number	:	305-992-3629

Provider Enumeration Date	:	04/02/2018
Last Update Date	:	04/02/2018

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