Healthcare Provider Details

I. General information

NPI: 1962172395
Provider Name (Legal Business Name): START PROFESSIONAL CARE & SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11117 W OKEECHOBEE RD STE 130
HIALEAH GARDENS FL
33018-4210
US

IV. Provider business mailing address

3300 E 5TH AVE
HIALEAH FL
33013-3037
US

V. Phone/Fax

Practice location:
  • Phone: 786-442-6465
  • Fax: 305-675-2397
Mailing address:
  • Phone: 786-442-6465
  • 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
# 3
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: MS. MADELIN MARICHAL
Title or Position: OWNER
Credential:
Phone: 786-442-6465