Healthcare Provider Details

I. General information

NPI: 1861822363
Provider Name (Legal Business Name): CATHOLIC PALLIATIVE CARE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 01/07/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14875 NW 77TH AVE SUITE 100
MIAMI LAKES FL
33014-2568
US

IV. Provider business mailing address

14875 NW 77TH AVE SUITE 100
MIAMI LAKES FL
33014-2568
US

V. Phone/Fax

Practice location:
  • Phone: 305-351-7057
  • Fax: 305-824-0665
Mailing address:
  • Phone: 305-351-7057
  • Fax: 305-824-0665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DIAN BACKOFF
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 305-351-7100