Provider Demographics
NPI:1841210226
Name:CORAL HOME CARE, INC.
Entity Type:Organization
Organization Name:CORAL HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:DE JESUS
Authorized Official - Last Name:AVELLANEDA
Authorized Official - Suffix:
Authorized Official - Credentials:CNA
Authorized Official - Phone:305-644-1819
Mailing Address - Street 1:3785 NW 82 AVE.
Mailing Address - Street 2:SUITE 217
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6655
Mailing Address - Country:US
Mailing Address - Phone:305-644-1819
Mailing Address - Fax:305-644-9691
Practice Address - Street 1:3785 NW 82 AVE.
Practice Address - Street 2:SUITE 217
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6655
Practice Address - Country:US
Practice Address - Phone:305-644-1819
Practice Address - Fax:305-644-9691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X
FL22073096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL684881800Medicaid
FL650821900Medicaid
FL684881800Medicaid