Provider Demographics
NPI:1609037209
Name:PRINCIPAL HOME CARE, INC.
Entity Type:Organization
Organization Name:PRINCIPAL HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOMINGO
Authorized Official - Middle Name:L
Authorized Official - Last Name:NAVARRO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-226-1341
Mailing Address - Street 1:275 FONTAINEBLEAU BLVD
Mailing Address - Street 2:SUITE 160C
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-4591
Mailing Address - Country:US
Mailing Address - Phone:305-226-1341
Mailing Address - Fax:305-226-1342
Practice Address - Street 1:275 FONTAINEBLEAU BLVD
Practice Address - Street 2:SUITE 160C
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4591
Practice Address - Country:US
Practice Address - Phone:305-226-1341
Practice Address - Fax:305-226-1342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993088251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health