Provider Demographics
NPI:1093759433
Name:INDAGO HEALTHCARE OF FLORIDA, INC.
Entity Type:Organization
Organization Name:INDAGO HEALTHCARE OF FLORIDA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIRRA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:610-237-1851
Mailing Address - Street 1:860 HIGHWAY ONE
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408
Mailing Address - Country:US
Mailing Address - Phone:561-776-5577
Mailing Address - Fax:561-776-5599
Practice Address - Street 1:860 HIGHWAY ONE
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408
Practice Address - Country:US
Practice Address - Phone:561-776-5577
Practice Address - Fax:561-776-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health