Provider Demographics
NPI:1346257235
Name:LAS MERCEDES HOME CARE CORP
Entity Type:Organization
Organization Name:LAS MERCEDES HOME CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TRULLENQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-857-9808
Mailing Address - Street 1:2103 CORAL WAY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145
Mailing Address - Country:US
Mailing Address - Phone:305-857-9808
Mailing Address - Fax:305-857-9906
Practice Address - Street 1:2103 CORAL WAY
Practice Address - Street 2:SUITE 107
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145
Practice Address - Country:US
Practice Address - Phone:305-857-9808
Practice Address - Fax:305-857-9906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA20640096251E00000X
FLHHA20640096(HOMEHEAL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650404300Medicaid
FL107665Medicare UPIN