Healthcare Provider Details

I. General information

NPI: 1225986862
Provider Name (Legal Business Name): CORAL CARE NURSING AGENCY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 MADRUGA AVE STE 303
CORAL GABLES FL
33146-3018
US

IV. Provider business mailing address

1550 MADRUGA AVE STE 303
CORAL GABLES FL
33146-3018
US

V. Phone/Fax

Practice location:
  • Phone: 786-606-9074
  • Fax:
Mailing address:
  • Phone: 786-606-9074
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANGIE FALLAS
Title or Position: CEO
Credential:
Phone: 786-606-9074