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General NPI Number Information
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NPI Number | 1942119276
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Entity Type | Organization
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Legal Business Name | LEGACY VIDA HEALTHCARE AGENCY LLC
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Dates
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Enumeration Date | 09/02/2026
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Last Update Date | 09/02/2026
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Provider Practice Location Address
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Address Line | 1747 NE 148TH ST
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City | MIAMI
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State | FL
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Zip | 33181-1046
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Country | US
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Telephone | 305-504-9173
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Fax |
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Provider Business Mailing Address
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Address Line | 1747 NE 148TH ST
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City | MIAMI
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State | FL
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Zip | 33181-1046
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Country | US
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Telephone | 305-504-9173
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | KIMBERLY COMEAU
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Credential |
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Telephone | 305-504-9173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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