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General NPI Number Information
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NPI Number | 1093967341
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Entity Type | Organization
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Legal Business Name | PRIDE CARE CENTER INC
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Dates
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Enumeration Date | 10/17/2008
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Last Update Date | 11/10/2009
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Provider Practice Location Address
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Address Line | 10875 OVERSEAS HWY STE 110
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City | MARATHON
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State | FL
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Zip | 33050-3454
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Country | US
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Telephone | 305-743-8130
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Fax | 305-743-8140
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Provider Business Mailing Address
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Address Line | 10875 OVERSEAS HWY STE 110
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City | MARATHON
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State | FL
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Zip | 33050-3454
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Country | US
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Telephone | 305-743-8130
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Fax | 305-743-8140
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MS. AIDA CARDENAS
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Credential |
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Telephone | 305-743-8130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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