Provider Demographics
NPI:1447760657
Name:AT TALITHA CUMI HOME CARE, INC.
Entity Type:Organization
Organization Name:AT TALITHA CUMI HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YASHIRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-454-7021
Mailing Address - Street 1:1840 W 49TH ST STE 224
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2949
Mailing Address - Country:US
Mailing Address - Phone:786-452-1226
Mailing Address - Fax:786-452-1227
Practice Address - Street 1:3600 S STATE ROAD 7 STE 363
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-7203
Practice Address - Country:US
Practice Address - Phone:786-452-1226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-03
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
FL234611372600000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive CareGroup - Single Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Single Specialty
No376J00000XNursing Service Related ProvidersHomemakerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002806208Medicaid