Provider Demographics
NPI:1962689125
Name:RESIDENCIA NUESTRA SENORA DE LA ESPERANZA, HOME CARE CORP.
Entity type:Organization
Organization Name:RESIDENCIA NUESTRA SENORA DE LA ESPERANZA, HOME CARE CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:
Authorized Official - Last Name:URRUTIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-386-5046
Mailing Address - Street 1:11125 SW 48TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-6118
Mailing Address - Country:US
Mailing Address - Phone:305-386-5046
Mailing Address - Fax:
Practice Address - Street 1:11125 SW 48TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-6118
Practice Address - Country:US
Practice Address - Phone:305-386-5046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8873310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL680975800Medicaid
FL140761900Medicaid