Provider Demographics
NPI:1003920554
Name:PREFERRED HOME HEALTH AGENCY, INC.
Entity Type:Organization
Organization Name:PREFERRED HOME HEALTH AGENCY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:YOANNER
Authorized Official - Middle Name:ROBERTO
Authorized Official - Last Name:CARDOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-388-4851
Mailing Address - Street 1:13831 SW 59TH ST STE 105
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-1150
Mailing Address - Country:US
Mailing Address - Phone:305-388-4851
Mailing Address - Fax:305-388-4852
Practice Address - Street 1:13831 SW 59TH ST STE 105
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-1150
Practice Address - Country:US
Practice Address - Phone:305-388-4851
Practice Address - Fax:305-388-4852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992046251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651215100Medicaid