Provider Demographics
NPI:1033663406
Name:PORTA NOVA HOMEMAKER COMPANION SERVICES,LLC
Entity Type:Organization
Organization Name:PORTA NOVA HOMEMAKER COMPANION SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALBA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PONCE DE LEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-595-0529
Mailing Address - Street 1:1320 N SEMORAN BLVD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3500
Mailing Address - Country:US
Mailing Address - Phone:407-440-8299
Mailing Address - Fax:407-704-4560
Practice Address - Street 1:1320 N SEMORAN BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3500
Practice Address - Country:US
Practice Address - Phone:407-440-8299
Practice Address - Fax:407-704-4560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-15
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 253Z00000X
FL385HR2060X, 385HR2065X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL014245800Medicaid
FL018812700Medicaid