Provider Demographics
NPI:1487835153
Name:RED ROAD HOME HEALTH SERVICE,INC
Entity Type:Organization
Organization Name:RED ROAD HOME HEALTH SERVICE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:JOGE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN, CCPA
Authorized Official - Phone:786-423-0649
Mailing Address - Street 1:4230 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-2306
Mailing Address - Country:US
Mailing Address - Phone:305-823-3312
Mailing Address - Fax:305-823-7932
Practice Address - Street 1:4230 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-2306
Practice Address - Country:US
Practice Address - Phone:305-823-3312
Practice Address - Fax:305-823-7932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9247805251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health