Healthcare Provider Details

I. General information

NPI: 1174942536
Provider Name (Legal Business Name): MG CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2014
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FONTAINEBLEAU BLVD STE 1R10
MIAMI FL
33172-4511
US

IV. Provider business mailing address

1600 SW 145TH AVE
MIAMI FL
33175-7469
US

V. Phone/Fax

Practice location:
  • Phone: 305-909-9104
  • Fax: 813-567-2400
Mailing address:
  • Phone: 305-343-0673
  • Fax: 813-567-2400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. MAXIMILLIAN ADRIAN GARCIA
Title or Position: PRESIDENT
Credential: BA
Phone: 305-343-0673