Provider Demographics
NPI:1922052851
Name:ELDERLY HEALTH HOME CARE INC
Entity Type:Organization
Organization Name:ELDERLY HEALTH HOME CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YAMILES
Authorized Official - Middle Name:
Authorized Official - Last Name:VALDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-884-6137
Mailing Address - Street 1:665 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6115
Mailing Address - Country:US
Mailing Address - Phone:305-884-6137
Mailing Address - Fax:305-884-6395
Practice Address - Street 1:665 MILLER DR
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-6115
Practice Address - Country:US
Practice Address - Phone:305-884-6137
Practice Address - Fax:305-884-6395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20321096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651283600Medicaid
FL108052Medicare PIN