Provider Demographics
NPI:1376625475
Name:KASSY HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:KASSY HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAFAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-256-2776
Mailing Address - Street 1:12855 SW 136TH AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-5885
Mailing Address - Country:US
Mailing Address - Phone:305-256-2776
Mailing Address - Fax:305-971-2656
Practice Address - Street 1:12855 SW 136TH AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5885
Practice Address - Country:US
Practice Address - Phone:305-256-2776
Practice Address - Fax:305-971-2656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL108368Medicare Oscar/Certification