=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144193053
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIAMI SUPREME HOME SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2025
-----------------------------------------------------
Last Update Date | 09/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7500 NW 25TH ST STE 200
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-909-4872
-----------------------------------------------------
Fax | 305-489-0896
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7500 NW 25TH ST STE 200
-----------------------------------------------------
City | DORAL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33122-1721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-909-4872
-----------------------------------------------------
Fax | 305-489-0896
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MIGUEL VALDES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 305-909-4872
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171W00000X
-----------------------------------------------------
Taxonomy Name | Contractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------