Provider Demographics
NPI:1215226857
Name:THIS IS YOUR HOME SERVICES, LLC
Entity Type:Organization
Organization Name:THIS IS YOUR HOME SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:A
Authorized Official - Last Name:AREVALO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-257-3079
Mailing Address - Street 1:PO BOX 640819
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:FL
Mailing Address - Zip Code:34464-3054
Mailing Address - Country:US
Mailing Address - Phone:352-257-3079
Mailing Address - Fax:352-527-8222
Practice Address - Street 1:2581 W APRICOT DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:FL
Practice Address - Zip Code:34465-3054
Practice Address - Country:US
Practice Address - Phone:352-257-3079
Practice Address - Fax:352-527-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL003061800320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003061800Medicaid