Provider Demographics
NPI:1487169785
Name:HONRANDO NUESTRAS CANAS LLC.
Entity type:Organization
Organization Name:HONRANDO NUESTRAS CANAS LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MRG
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:LUISA
Authorized Official - Last Name:GONZALEZ CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-812-3961
Mailing Address - Street 1:PO BOX 5109
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33845-5109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1845 ALTERNATE S27
Practice Address - Street 2:
Practice Address - City:LAKE HAMILTON
Practice Address - State:FL
Practice Address - Zip Code:33851
Practice Address - Country:US
Practice Address - Phone:863-812-3961
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8638123961Medicaid