Healthcare Provider Details

I. General information

NPI: 1356925572
Provider Name (Legal Business Name): XTREME CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2021
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18191 NW 68TH AVE STE 215
HIALEAH FL
33015-3998
US

IV. Provider business mailing address

18191 NW 68TH AVE STE 215
HIALEAH FL
33015-3998
US

V. Phone/Fax

Practice location:
  • Phone: 305-364-5214
  • Fax: 786-332-2359
Mailing address:
  • Phone: 305-364-5214
  • Fax: 786-332-2359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name: YUSIMIL DE LA NOVAL
Title or Position: OWNER
Credential:
Phone: 786-663-6714