Provider Demographics
NPI:1720344922
Name:PROJECT INDEPENDENCE AT HOME
Entity Type:Organization
Organization Name:PROJECT INDEPENDENCE AT HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-762-1380
Mailing Address - Street 1:7415 CORPORATE CENTER DR
Mailing Address - Street 2:BUILDING 6 BAY H
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-1204
Mailing Address - Country:US
Mailing Address - Phone:305-758-0021
Mailing Address - Fax:305-758-7406
Practice Address - Street 1:7415 CORPORATE CENTER DR
Practice Address - Street 2:BUILDING 6 BAY H
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-1204
Practice Address - Country:US
Practice Address - Phone:305-758-0021
Practice Address - Fax:305-758-7406
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLORIDA PACE CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015032101Medicaid
FL015032110Medicaid