Provider Demographics
NPI:1033370135
Name:SPIRIT HOME HEALTH CARE CORP
Entity Type:Organization
Organization Name:SPIRIT HOME HEALTH CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCISCO
Authorized Official - Middle Name:J
Authorized Official - Last Name:BERNAL PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-227-2111
Mailing Address - Street 1:175 FONTAINEBLEAU BLVD
Mailing Address - Street 2:SUITE 2K7
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-7012
Mailing Address - Country:US
Mailing Address - Phone:305-227-2111
Mailing Address - Fax:305-227-2118
Practice Address - Street 1:175 FONTAINEBLEAU BLVD
Practice Address - Street 2:SUITE 2K7
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-7012
Practice Address - Country:US
Practice Address - Phone:305-227-2111
Practice Address - Fax:305-227-2118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCCN 10-9356OtherMEDICARE UNSPECIFIED