Provider Demographics
NPI:1134695133
Name:HISPANO AMERICAN HOME CARE LLC
Entity Type:Organization
Organization Name:HISPANO AMERICAN HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-404-0077
Mailing Address - Street 1:1714 E IRLO BRONSON MEMORIAL HWY STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-5836
Mailing Address - Country:US
Mailing Address - Phone:407-583-4795
Mailing Address - Fax:
Practice Address - Street 1:1700 E IRLO BRONSON MEMORIAL HWY OFC 1714A
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-5806
Practice Address - Country:US
Practice Address - Phone:407-583-4795
Practice Address - Fax:407-583-6412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-17
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health