Provider Demographics
NPI:1699969519
Name:PSN HEALTH CARE CORP
Entity type:Organization
Organization Name:PSN HEALTH CARE CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEYDI
Authorized Official - Middle Name:
Authorized Official - Last Name:FALCON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:305-698-5295
Mailing Address - Street 1:17670 NW 78TH AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-3664
Mailing Address - Country:US
Mailing Address - Phone:305-698-5295
Mailing Address - Fax:305-698-5325
Practice Address - Street 1:17670 NW 78TH AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3664
Practice Address - Country:US
Practice Address - Phone:305-698-5295
Practice Address - Fax:305-698-5325
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992845251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL299992845OtherAHCA
FL651782000Medicaid
FL651782000Medicaid