Provider Demographics
NPI:1184715682
Name:VIRGIN HEALTH CORPORATION
Entity type:Organization
Organization Name:VIRGIN HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:V
Authorized Official - Last Name:DE LA CRUZ JR.
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-818-1710
Mailing Address - Street 1:5735 NW 84TH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-3310
Mailing Address - Country:US
Mailing Address - Phone:305-818-1710
Mailing Address - Fax:833-630-9883
Practice Address - Street 1:5735 NW 84TH AVE # 101
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-3310
Practice Address - Country:US
Practice Address - Phone:305-818-1710
Practice Address - Fax:833-630-9883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992258251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651308500Medicaid