Provider Demographics
NPI:1619960341
Name:HOME NURSE CORP.
Entity Type:Organization
Organization Name:HOME NURSE CORP.
Other - Org Name:THE PALACE AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:CESAR
Authorized Official - Last Name:CHACON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-275-2533
Mailing Address - Street 1:10850 SW 113TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-3227
Mailing Address - Country:US
Mailing Address - Phone:305-275-2533
Mailing Address - Fax:305-270-7037
Practice Address - Street 1:10850 SW 113TH PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-3227
Practice Address - Country:US
Practice Address - Phone:305-275-2533
Practice Address - Fax:305-270-7037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2009-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHHA299991072251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
107653Medicare ID - Type Unspecified