Healthcare Provider Details

I. General information

NPI: 1841862919
Provider Name (Legal Business Name): MIAMI SUPREME HOME SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2021
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7500 NW 25TH ST STE 200
MIAMI FL
33122-1721
US

IV. Provider business mailing address

PO BOX 832856
MIAMI FL
33283-2856
US

V. Phone/Fax

Practice location:
  • Phone: 305-909-4872
  • Fax:
Mailing address:
  • Phone: 305-909-4872
  • Fax:

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: MIGUEL VALDES
Title or Position: OWNER
Credential:
Phone: 305-909-4872