Provider Demographics
NPI:1003849530
Name:WILLSAND HOME HEALTH AGENCY, INC
Entity Type:Organization
Organization Name:WILLSAND HOME HEALTH AGENCY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:EULISES
Authorized Official - Middle Name:
Authorized Official - Last Name:ESCALONA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-871-5511
Mailing Address - Street 1:9621 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4030
Mailing Address - Country:US
Mailing Address - Phone:305-871-5511
Mailing Address - Fax:305-871-6611
Practice Address - Street 1:9621 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-4030
Practice Address - Country:US
Practice Address - Phone:305-871-5511
Practice Address - Fax:305-871-6611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299991519251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651056600Medicaid
FL651056600Medicaid