Healthcare Provider Details

I. General information

NPI: 1912140930
Provider Name (Legal Business Name): MED-PAL HOME HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 04/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 MIAMI LAKES DR SUITE 374
MIAMI LAKES FL
33014-2708
US

IV. Provider business mailing address

6625 MIAMI LAKES DR SUITE 374
MIAMI LAKES FL
33014-2708
US

V. Phone/Fax

Practice location:
  • Phone: 305-777-3809
  • Fax: 786-360-6621
Mailing address:
  • Phone: 305-777-3809
  • Fax: 786-360-6621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: VICENTE HIDALGO
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-777-3809