Provider Demographics
NPI:1790926541
Name:ELOHIM BARA / RAPHA HOME & HOSPITAL FOR THE AGED CORP
Entity Type:Organization
Organization Name:ELOHIM BARA / RAPHA HOME & HOSPITAL FOR THE AGED CORP
Other - Org Name:EBR HOME & HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:PR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DJENANE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN
Authorized Official - Suffix:
Authorized Official - Credentials:NR
Authorized Official - Phone:786-201-0137
Mailing Address - Street 1:1175 NW 132ND ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-6625
Mailing Address - Country:US
Mailing Address - Phone:786-201-0137
Mailing Address - Fax:
Practice Address - Street 1:1175 NW 132ND ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-6625
Practice Address - Country:US
Practice Address - Phone:786-201-0137
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization