Provider Demographics
NPI:1225445190
Name:AT TALITHA CUMI HOME CARE, INC
Entity Type:Organization
Organization Name:AT TALITHA CUMI HOME CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YASHIRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-454-7021
Mailing Address - Street 1:1840 W 49TH ST STE 224
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2949
Mailing Address - Country:US
Mailing Address - Phone:786-452-1226
Mailing Address - Fax:786-452-1227
Practice Address - Street 1:2328 HANCOCK BRIDGE PKWY STE 112A
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-1455
Practice Address - Country:US
Practice Address - Phone:786-452-1226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-12
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL233664251E00000X, 253Z00000X
3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No251E00000XAgenciesHome Health
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002806201Medicaid