Provider Demographics
NPI:1134308018
Name:ADVANCED NURSING HOMECARE SERVICES INC
Entity Type:Organization
Organization Name:ADVANCED NURSING HOMECARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:COSME
Authorized Official - Middle Name:J
Authorized Official - Last Name:LLERENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-827-5551
Mailing Address - Street 1:15271 NW 60TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2422
Mailing Address - Country:US
Mailing Address - Phone:305-827-5551
Mailing Address - Fax:305-824-5101
Practice Address - Street 1:15271 NW 60TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2422
Practice Address - Country:US
Practice Address - Phone:305-827-5551
Practice Address - Fax:305-824-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992922251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299992922OtherAHCA LICENSE