Provider Demographics
NPI:1912782103
Name:CRUZ HOMECARE LLC
Entity Type:Organization
Organization Name:CRUZ HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADIMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:JAIMAR
Authorized Official - Middle Name:Z
Authorized Official - Last Name:GONZALEZ CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-525-0593
Mailing Address - Street 1:1899 CASSIDY KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:KINDRED
Mailing Address - State:FL
Mailing Address - Zip Code:34744-6143
Mailing Address - Country:US
Mailing Address - Phone:321-525-0593
Mailing Address - Fax:
Practice Address - Street 1:1899 CASSIDY KNOLL DR
Practice Address - Street 2:
Practice Address - City:KINDRED
Practice Address - State:FL
Practice Address - Zip Code:34744-6143
Practice Address - Country:US
Practice Address - Phone:321-525-0593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health