MEDICARE: BLANCO HOME HEALTH CARE CORPORATION

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	8370	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699977553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLANCO HOME HEALTH CARE CORPORATION

Provider Business Mailing Address
First Line	:	604 NW 25TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-4444
Country	:	US
Telephone Number	:	305-649-9299
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 NW 25TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33125-4444
Country	:	US
Telephone Number	:	305-649-9299
Fax Number	:

Authorized Official
Title or Position	:	PRESDENT
Name	:	JENNY PICHARDO
Credential	:
Telephone Number	:	305-649-9299

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	01/28/2012

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