Provider Demographics
NPI:1770857609
Name:HOME DR INC
Entity Type:Organization
Organization Name:HOME DR INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:787-439-2141
Mailing Address - Street 1:1201 E SUNRISE BLVD
Mailing Address - Street 2:UNIT 601
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2880
Mailing Address - Country:US
Mailing Address - Phone:787-439-2141
Mailing Address - Fax:
Practice Address - Street 1:1201 E SUNRISE BLVD
Practice Address - Street 2:UNIT 601
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-2880
Practice Address - Country:US
Practice Address - Phone:787-439-2141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2017-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
PR17951208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome HealthGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty