Provider Demographics
NPI:1356371017
Name:MEDEX HOME CARE INC.
Entity type:Organization
Organization Name:MEDEX HOME CARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEX
Authorized Official - Middle Name:
Authorized Official - Last Name:LLANES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-463-9490
Mailing Address - Street 1:8250 NW 27TH ST
Mailing Address - Street 2:309
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33122-1904
Mailing Address - Country:US
Mailing Address - Phone:305-463-9490
Mailing Address - Fax:305-463-7576
Practice Address - Street 1:8250 NW 27TH ST
Practice Address - Street 2:309
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33122-1904
Practice Address - Country:US
Practice Address - Phone:305-463-9490
Practice Address - Fax:305-463-7576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20697096251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL650913400Medicaid
FL107696Medicare ID - Type UnspecifiedHOME HEALTH PROVIDER