Healthcare Provider Details

I. General information

NPI: 1336794387
Provider Name (Legal Business Name): SOUTH FLORIDA PPEC SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2019
Last Update Date: 08/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15383 NW 7TH AVE STE B
MIAMI FL
33169-6205
US

IV. Provider business mailing address

961 NE 175TH ST
MIAMI FL
33162-2142
US

V. Phone/Fax

Practice location:
  • Phone: 917-515-5967
  • Fax:
Mailing address:
  • Phone: 917-515-5967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MAXWELL BERKOWITZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 917-515-5967