Healthcare Provider Details

I. General information

NPI: 1386551844
Provider Name (Legal Business Name): VIDAWELL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 HARRISON ST STE 8
HOLLYWOOD FL
33020-5017
US

IV. Provider business mailing address

10700 CARIBBEAN BLVD STE 202-12
CUTLER BAY FL
33189-1224
US

V. Phone/Fax

Practice location:
  • Phone: 305-395-3561
  • Fax: 305-230-7990
Mailing address:
  • Phone: 305-395-3561
  • Fax: 305-230-7990

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: MAYARA ORTIZ FERNANDEZ
Title or Position: OWNER
Credential:
Phone: 786-670-0011