Provider Demographics
NPI:1588670038
Name:RENOVATION HOME HEALTH CARE,INC
Entity type:Organization
Organization Name:RENOVATION HOME HEALTH CARE,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALFARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-552-5248
Mailing Address - Street 1:943 SW 122ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2406
Mailing Address - Country:US
Mailing Address - Phone:305-552-5248
Mailing Address - Fax:305-552-5608
Practice Address - Street 1:943 SW 122ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2406
Practice Address - Country:US
Practice Address - Phone:305-552-5248
Practice Address - Fax:305-552-5608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992298251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL651464200Medicaid
FL651464200Medicaid