Provider Demographics
NPI:1811142953
Name:PROFESSIONAL HOME HEALTH CARE, INC.
Entity type:Organization
Organization Name:PROFESSIONAL HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-558-9960
Mailing Address - Street 1:4155 SW 130TH AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3414
Mailing Address - Country:US
Mailing Address - Phone:305-558-9960
Mailing Address - Fax:305-558-9943
Practice Address - Street 1:4155 SW 130TH AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-3414
Practice Address - Country:US
Practice Address - Phone:305-558-9960
Practice Address - Fax:305-558-9943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-17
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993613251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109623OtherMEDICARE