Provider Demographics
NPI:1033298039
Name:HOME LIFE, LLC
Entity Type:Organization
Organization Name:HOME LIFE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TRUEBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-225-3900
Mailing Address - Street 1:175 FONTAINEBLEAU BLVD. SUITE 1 G 3
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-7018
Mailing Address - Country:US
Mailing Address - Phone:305-225-3900
Mailing Address - Fax:305-225-3940
Practice Address - Street 1:175 FONTAINEBLEAU BLVD.
Practice Address - Street 2:SUITE 1G3
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-7018
Practice Address - Country:US
Practice Address - Phone:305-225-3900
Practice Address - Fax:305-225-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109363Medicare Oscar/Certification