Provider Demographics
NPI:1730127754
Name:MEDIADVANTAGE HOME HEALTH SERVICES CORP
Entity Type:Organization
Organization Name:MEDIADVANTAGE HOME HEALTH SERVICES CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:CARMONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-621-5444
Mailing Address - Street 1:8180 NW 36TH ST
Mailing Address - Street 2:414
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6645
Mailing Address - Country:US
Mailing Address - Phone:786-621-5444
Mailing Address - Fax:786-621-5445
Practice Address - Street 1:8180 NW 36TH ST
Practice Address - Street 2:414
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6645
Practice Address - Country:US
Practice Address - Phone:786-621-5444
Practice Address - Fax:786-621-5445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651054000Medicaid
FL108098Medicare ID - Type UnspecifiedPROVIDER NUMBER