Provider Demographics
NPI:1912102005
Name:HIS HOUSE, INC.
Entity Type:Organization
Organization Name:HIS HOUSE, INC.
Other - Org Name:HIS HOUSE CHILDREN'S HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR AND PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CACERES-GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-430-0085
Mailing Address - Street 1:20000 NW 47TH AVE
Mailing Address - Street 2:HECTOR BUILDING NO. 2
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33055-1543
Mailing Address - Country:US
Mailing Address - Phone:305-430-0085
Mailing Address - Fax:305-430-8533
Practice Address - Street 1:20000 NW 47TH AVE
Practice Address - Street 2:HECTOR BUILDING NO. 2
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33055-1543
Practice Address - Country:US
Practice Address - Phone:305-430-0085
Practice Address - Fax:305-430-8533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management