Healthcare Provider Details

I. General information

NPI: 1093012155
Provider Name (Legal Business Name): BAMM SERVICES GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6373 SW 165TH AVE
MIAMI FL
33193-4482
US

IV. Provider business mailing address

6373 SW 165TH AVE
MIAMI FL
33193-4482
US

V. Phone/Fax

Practice location:
  • Phone: 786-586-1045
  • Fax:
Mailing address:
  • Phone: 786-586-1045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberOT 9891
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberOT 9891
License Number StateFL

VIII. Authorized Official

Name: MARGARITA MARIA DEL VALLE
Title or Position: PRESIDENT
Credential:
Phone: 786-586-1045