Healthcare Provider Details

I. General information

NPI: 1346919057
Provider Name (Legal Business Name): PUERTO AMIGO HOME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 N COUNTRY CLUB DR APT 501
AVENTURA FL
33180-1614
US

IV. Provider business mailing address

3301 N COUNTRY CLUB DR APT 501
AVENTURA FL
33180-1614
US

V. Phone/Fax

Practice location:
  • Phone: 954-599-5185
  • Fax:
Mailing address:
  • Phone: 954-599-5185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. IVAN GEOVANNI BERMEO
Title or Position: MANAGER
Credential:
Phone: 954-599-5185