Provider Demographics
NPI:1326095456
Name:HUMANA CARE CENTER INC
Entity Type:Organization
Organization Name:HUMANA CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:EDUARDO
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-628-2177
Mailing Address - Street 1:4715 NW 157TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6435
Mailing Address - Country:US
Mailing Address - Phone:305-628-2177
Mailing Address - Fax:305-628-2178
Practice Address - Street 1:4715 NW 157TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-6435
Practice Address - Country:US
Practice Address - Phone:305-628-2177
Practice Address - Fax:305-628-2178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9602Medicare ID - Type Unspecified