Healthcare Provider Details

I. General information

NPI: 1578380085
Provider Name (Legal Business Name): MIAMI HOMECARE USA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 W HALLANDALE BEACH BLVD STE 11
PEMBROKE PARK FL
33023-4344
US

IV. Provider business mailing address

4520 W HALLANDALE BEACH BLVD STE 11
PEMBROKE PARK FL
33023-4344
US

V. Phone/Fax

Practice location:
  • Phone: 754-310-2273
  • Fax: 954-589-5626
Mailing address:
  • Phone: 754-310-2237
  • Fax: 954-589-5626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. LEONID YEVDAYEV
Title or Position: ADMINISTRATOR
Credential:
Phone: 754-310-2273