Healthcare Provider Details

I. General information

NPI: 1164181202
Provider Name (Legal Business Name): EXECUTIVE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11010 N KENDALL DR STE 100
MIAMI FL
33176-1205
US

IV. Provider business mailing address

11010 N KENDALL DR STE 100
MIAMI FL
33176-1205
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-6471
  • Fax:
Mailing address:
  • Phone: 305-274-6471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ARMANDO MORALES
Title or Position: CEO
Credential:
Phone: 305-274-6471