MEDICARE: MISLE LEGACY CARE CONSULTING LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1700754389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MISLE LEGACY CARE CONSULTING LLC

Provider Business Mailing Address
First Line	:	2775 W OKEECHOBEE RD LOT 9
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-1061
Country	:	US
Telephone Number	:	305-721-6295
Fax Number	:

Provider Business Practice Location Address
First Line	:	2775 W OKEECHOBEE RD LOT 9
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33010-1061
Country	:	US
Telephone Number	:	305-721-6295
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MISLENYS CASAS RODRIGUEZ
Credential	:
Telephone Number	:	305-721-6295

Provider Enumeration Date	:	10/27/2025
Last Update Date	:	10/27/2025

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