Healthcare Provider Details

I. General information

NPI: 1558778605
Provider Name (Legal Business Name): FAMILY LIFE CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17680 NW 78TH AVE STE 105
HIALEAH FL
33015-3667
US

IV. Provider business mailing address

17680 NW 78TH AVE STE 105
HIALEAH FL
33015-3667
US

V. Phone/Fax

Practice location:
  • Phone: 305-779-1068
  • Fax: 305-779-1067
Mailing address:
  • Phone: 305-779-1068
  • Fax: 305-779-1067

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 Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: MR. DERICK R TORO
Title or Position: PRESIDENT
Credential:
Phone: 305-779-1068