Provider Demographics
NPI:1326244245
Name:COMPANION HOME CORP.
Entity Type:Organization
Organization Name:COMPANION HOME CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIRIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:COMPANIONI
Authorized Official - Suffix:I
Authorized Official - Credentials:CNA
Authorized Official - Phone:305-854-2631
Mailing Address - Street 1:1997 SW 17TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2707
Mailing Address - Country:US
Mailing Address - Phone:305-854-2631
Mailing Address - Fax:305-860-7723
Practice Address - Street 1:1997 SW 17TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2707
Practice Address - Country:US
Practice Address - Phone:305-854-2631
Practice Address - Fax:305-860-7723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL78933104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL676160700Medicaid