Provider Demographics
NPI:1548435852
Name:MARTHA'S HOME CARE
Entity type:Organization
Organization Name:MARTHA'S HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:MISS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FLOREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-953-4221
Mailing Address - Street 1:P.O. BOX 623162
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32762-8309
Mailing Address - Country:US
Mailing Address - Phone:407-953-4221
Mailing Address - Fax:407-275-3264
Practice Address - Street 1:9165 LEE VISTA BLVD APT 107
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-8309
Practice Address - Country:US
Practice Address - Phone:407-275-3264
Practice Address - Fax:407-275-3264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-28
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL230485251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000276600Medicaid