Healthcare Provider Details

I. General information

NPI: 1104750827
Provider Name (Legal Business Name): 365 MEDICAL CAREJ LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3517 SW 169TH TER
MIRAMAR FL
33027-4567
US

IV. Provider business mailing address

1150 SW HALEYBERRY AVE
PORT SAINT LUCIE FL
34953-6830
US

V. Phone/Fax

Practice location:
  • Phone: 989-402-1073
  • Fax:
Mailing address:
  • Phone: 262-408-5434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MARIO M JOHNSON
Title or Position: OWNER
Credential:
Phone: 262-408-5434