Provider Demographics
NPI:1720765167
Name:THALINA HOMECARE COMPANION AGENCY
Entity Type:Organization
Organization Name:THALINA HOMECARE COMPANION AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ECLENA
Authorized Official - Middle Name:
Authorized Official - Last Name:MATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:929-313-8247
Mailing Address - Street 1:1719 MESSINA AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-4832
Mailing Address - Country:US
Mailing Address - Phone:321-557-8588
Mailing Address - Fax:
Practice Address - Street 1:1719 MESSINA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-4832
Practice Address - Country:US
Practice Address - Phone:321-557-8588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities