Provider Demographics
NPI:1801363080
Name:ILDEXYS HOME HEALTH CARE CORP
Entity Type:Organization
Organization Name:ILDEXYS HOME HEALTH CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERIBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALADRO DE PUPO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-926-9421
Mailing Address - Street 1:3340 NW 80TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-4623
Mailing Address - Country:US
Mailing Address - Phone:786-631-5934
Mailing Address - Fax:786-615-2749
Practice Address - Street 1:3340 NW 80TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33147-4623
Practice Address - Country:US
Practice Address - Phone:786-631-5934
Practice Address - Fax:786-615-2749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-25
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAL13229Medicaid