Provider Demographics
NPI:1376562520
Name:MED PRO HOME HEALTH CARE CONSULTANTS, LLC.
Entity Type:Organization
Organization Name:MED PRO HOME HEALTH CARE CONSULTANTS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-400-4818
Mailing Address - Street 1:1065 NE 125TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5821
Mailing Address - Country:US
Mailing Address - Phone:305-400-4818
Mailing Address - Fax:305-400-4824
Practice Address - Street 1:1065 NE 125TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-5821
Practice Address - Country:US
Practice Address - Phone:305-400-4818
Practice Address - Fax:305-400-4824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992399251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299992399OtherAHCA LICENSE