Provider Demographics
NPI:1063090876
Name:DIBAR HOME CARE , LLC
Entity type:Organization
Organization Name:DIBAR HOME CARE , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MORAIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-818-8691
Mailing Address - Street 1:10610 SW 199TH ST BAY 199TH
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-8515
Mailing Address - Country:US
Mailing Address - Phone:786-818-8691
Mailing Address - Fax:305-330-9080
Practice Address - Street 1:10610 SW 199TH ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-8515
Practice Address - Country:US
Practice Address - Phone:786-818-8691
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020999000Medicaid