Provider Demographics
NPI:1659477263
Name:DOS OF HIALEAH, INC
Entity Type:Organization
Organization Name:DOS OF HIALEAH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HERNANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-868-1830
Mailing Address - Street 1:8785 NW 32ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-3705
Mailing Address - Country:US
Mailing Address - Phone:305-691-5711
Mailing Address - Fax:305-691-6707
Practice Address - Street 1:8785 NW 32ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-3705
Practice Address - Country:US
Practice Address - Phone:305-691-5711
Practice Address - Fax:305-691-6707
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF1399096314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL025098800Medicaid
FL105511Medicare ID - Type UnspecifiedMEDICARE