Healthcare Provider Details

I. General information

NPI: 1912510751
Provider Name (Legal Business Name): ABC HEALTH CARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2020
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9766 SW 24TH ST STE 17AND
MIAMI FL
33165-7539
US

IV. Provider business mailing address

9766 SW 24TH ST STE 17AND
MIAMI FL
33165-7539
US

V. Phone/Fax

Practice location:
  • Phone: 786-706-1281
  • Fax:
Mailing address:
  • Phone: 786-706-1281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREETTEL O PORTAL
Title or Position: MBR
Credential:
Phone: 305-748-3462