MEDICARE: VIVES HEALTHCARE SERVICES, INC.

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	261QD1600X	Developmental Disabilities Clinic/Center

General Provider Information

NPI Number	:	1851941181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIVES HEALTHCARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	4961 NW 181ST TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4961 NW 181ST TER
Second Line	:
City	:	MIAMI GARDENS
State	:	FL
Zip	:	33055-2916
Country	:	US
Telephone Number	:	786-443-4799
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MARGARITA VIVES
Credential	:
Telephone Number	:	786-443-4799

Provider Enumeration Date	:	09/18/2019
Last Update Date	:	09/18/2019

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