Provider Demographics
NPI:1396980587
Name:UNIVERSAL HEALTH PROVIDER, CORP.
Entity type:Organization
Organization Name:UNIVERSAL HEALTH PROVIDER, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANABELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-265-8753
Mailing Address - Street 1:9780 E INDIGO ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5609
Mailing Address - Country:US
Mailing Address - Phone:305-265-8753
Mailing Address - Fax:305-265-8771
Practice Address - Street 1:9780 E INDIGO ST
Practice Address - Street 2:SUITE 202
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5609
Practice Address - Country:US
Practice Address - Phone:305-265-8753
Practice Address - Fax:305-265-8771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299993431251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL109572Medicare Oscar/Certification