Provider Demographics
NPI:1154485282
Name:TC HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:TC HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:IDALMIS
Authorized Official - Middle Name:
Authorized Official - Last Name:CORDERO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-823-5457
Mailing Address - Street 1:7600 W 20TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1821
Mailing Address - Country:US
Mailing Address - Phone:305-823-5457
Mailing Address - Fax:
Practice Address - Street 1:7600 W 20TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1821
Practice Address - Country:US
Practice Address - Phone:305-823-5457
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL099991910251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651107400Medicaid
FL108186Medicare ID - Type UnspecifiedPROVIDER NUMBER