Provider Demographics
NPI:1376751503
Name:LILI'S HOME CARE, CORP.
Entity Type:Organization
Organization Name:LILI'S HOME CARE, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:ANDRES
Authorized Official - Last Name:MOGOLLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-305-2400
Mailing Address - Street 1:6321 S.W. 20 TERR.
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155
Mailing Address - Country:US
Mailing Address - Phone:305-262-9287
Mailing Address - Fax:305-262-9287
Practice Address - Street 1:6321 S.W. 20 TERR.
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:305-262-9287
Practice Address - Fax:305-262-9287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-20
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 9272310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140494600Medicaid
FL683764600Medicaid