Provider Demographics
NPI:1578129912
Name:IDA'S HOME LLC
Entity Type:Organization
Organization Name:IDA'S HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:IDANIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-370-3479
Mailing Address - Street 1:12853 SW 147TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-6390
Mailing Address - Country:US
Mailing Address - Phone:786-250-4917
Mailing Address - Fax:786-250-4917
Practice Address - Street 1:12853 SW 147TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6390
Practice Address - Country:US
Practice Address - Phone:786-250-4917
Practice Address - Fax:786-250-4917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-10
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility