Provider Demographics
NPI:1306131107
Name:HYBRID HEALTHCARE STAFFING AGENCY. LLC
Entity type:Organization
Organization Name:HYBRID HEALTHCARE STAFFING AGENCY. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADETUTU
Authorized Official - Middle Name:
Authorized Official - Last Name:AJAGBE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:305-477-7811
Mailing Address - Street 1:4995 NW 72ND AVE STE 307
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33166-5643
Mailing Address - Country:US
Mailing Address - Phone:305-477-7811
Mailing Address - Fax:305-593-8225
Practice Address - Street 1:4995 NW 72ND AVE STE 307
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33166-5643
Practice Address - Country:US
Practice Address - Phone:305-477-7811
Practice Address - Fax:305-593-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAHCA # 30211162251E00000X, 251J00000X, 253Z00000X, 251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30211162OtherSTATE OF FLORIDA AHCA LICENSE NUMBER