Provider Demographics
NPI:1225295082
Name:DA LOURDES SERVICES CORP
Entity Type:Organization
Organization Name:DA LOURDES SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORENO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-968-7525
Mailing Address - Street 1:15605 SW 178TH LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-7805
Mailing Address - Country:US
Mailing Address - Phone:305-968-7525
Mailing Address - Fax:305-253-3027
Practice Address - Street 1:15605 SW 178TH LN
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-7805
Practice Address - Country:US
Practice Address - Phone:305-968-7525
Practice Address - Fax:305-253-3027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001878300Medicaid
FL688419996Medicaid
FL688419998Medicaid