MEDICARE: HIS HOUSE, 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	253J00000X	Foster Care Agency		FL
2	251S00000X	Community/Behavioral Health Agency

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568846756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIS HOUSE, INC.

Provider Business Mailing Address
First Line	:	20000 NW 47TH AVE
Second Line	:	HECTOR BUILDING NO. 2
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-1543
Country	:	US
Telephone Number	:	305-430-0085
Fax Number	:	305-474-8533

Provider Business Practice Location Address
First Line	:	20000 NW 47TH AVE
Second Line	:	HECTOR BUILDING NO. 2
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-1543
Country	:	US
Telephone Number	:	305-430-0085
Fax Number	:	305-474-8533

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. SILVIA SMITH-TORRES
Credential	:
Telephone Number	:	305-430-0085

Provider Enumeration Date	:	07/17/2015
Last Update Date	:	02/28/2018

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Directions to “HIS HOUSE, INC. ” Practice Location

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