Provider Demographics
NPI:1710091434
Name:MED GROUP HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:MED GROUP HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:
Authorized Official - Last Name:FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-817-3032
Mailing Address - Street 1:7500 NW 25TH ST
Mailing Address - Street 2:SUITE-235
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1713
Mailing Address - Country:US
Mailing Address - Phone:305-817-3032
Mailing Address - Fax:305-817-3330
Practice Address - Street 1:7500 NW 25TH ST
Practice Address - Street 2:SUITE-235
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33122-1713
Practice Address - Country:US
Practice Address - Phone:305-817-3032
Practice Address - Fax:305-817-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992452251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health