Provider Demographics
NPI:1104010644
Name:SOUTH FLORIDA HOME CARE GROUP CORP
Entity Type:Organization
Organization Name:SOUTH FLORIDA HOME CARE GROUP CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/D.O.N.
Authorized Official - Prefix:
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DE VARONA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:786-900-0087
Mailing Address - Street 1:3408 W 84TH ST STE 117B
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4941
Mailing Address - Country:US
Mailing Address - Phone:786-900-0087
Mailing Address - Fax:786-900-0088
Practice Address - Street 1:3408 W 84TH ST STE 117B
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4941
Practice Address - Country:US
Practice Address - Phone:786-900-0087
Practice Address - Fax:786-900-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2009-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992853251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299992853OtherAHCA
FL299992853OtherMEDICARE