Healthcare Provider Details

I. General information

NPI: 1265359434
Provider Name (Legal Business Name): COUNTRY WALK CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14621 SW 143RD PLACE CIR
MIAMI FL
33186-5670
US

IV. Provider business mailing address

14621 SW 143RD PLACE CIR
MIAMI FL
33186-5670
US

V. Phone/Fax

Practice location:
  • Phone: 305-542-2664
  • Fax: 786-701-8274
Mailing address:
  • Phone: 305-542-2664
  • Fax: 786-701-8274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHEL MARTINEZ MENENDEZ
Title or Position: OWNER
Credential:
Phone: 305-316-4625