Provider Demographics
NPI:1033812250
Name:SPECIALIZED ELDER CARE SERVICES FLORIDA LLC
Entity Type:Organization
Organization Name:SPECIALIZED ELDER CARE SERVICES FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:RIK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-406-4182
Mailing Address - Street 1:2420 NE 194TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2159
Mailing Address - Country:US
Mailing Address - Phone:510-406-4182
Mailing Address - Fax:
Practice Address - Street 1:2420 NE 194TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33180-2159
Practice Address - Country:US
Practice Address - Phone:510-406-4182
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty