Healthcare Provider Details

I. General information

NPI: 1417470659
Provider Name (Legal Business Name): PORT ROYAL HOME HEALTH CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NW 183RD ST STE 318B
MIAMI FL
33169-4537
US

IV. Provider business mailing address

111 NW 183RD ST STE 318B
MIAMI FL
33169-4537
US

V. Phone/Fax

Practice location:
  • Phone: 305-337-1717
  • Fax: 786-440-5046
Mailing address:
  • Phone: 305-337-1717
  • Fax: 786-440-5046

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name: KRISTO-JAY BAILEY
Title or Position: CEO
Credential:
Phone: 305-337-1717