Provider Demographics
NPI:1730259656
Name:1ST CLASS HOME HEALTH, INC
Entity type:Organization
Organization Name:1ST CLASS HOME HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:TORREZ QUINTANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-513-3885
Mailing Address - Street 1:1414 NW 107TH AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2732
Mailing Address - Country:US
Mailing Address - Phone:305-513-3885
Mailing Address - Fax:305-513-4061
Practice Address - Street 1:1414 NW 107TH AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2732
Practice Address - Country:US
Practice Address - Phone:305-513-3885
Practice Address - Fax:305-513-4061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299992238251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6512771Medicaid
FL108301Medicare Oscar/Certification