Healthcare Provider Details

I. General information

NPI: 1265197743
Provider Name (Legal Business Name): MC SAPPHIRE SERVICE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3511 VALERIE BLVD
SEBRING FL
33870-7812
US

IV. Provider business mailing address

3511 VALERIE BLVD
SEBRING FL
33870-7812
US

V. Phone/Fax

Practice location:
  • Phone: 502-818-7324
  • Fax:
Mailing address:
  • Phone: 502-818-7324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: RAUL MIGUEL RUBIRA RAMOS
Title or Position: PRESIDENT
Credential: HHA
Phone: 502-818-7324