Provider Demographics
NPI:1093967341
Name:PRIDE CARE CENTER INC
Entity Type:Organization
Organization Name:PRIDE CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDENAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-743-8130
Mailing Address - Street 1:10875 OVERSEAS HWY STE 110
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-3454
Mailing Address - Country:US
Mailing Address - Phone:305-743-8130
Mailing Address - Fax:305-743-8140
Practice Address - Street 1:10875 OVERSEAS HWY STE 110
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-3454
Practice Address - Country:US
Practice Address - Phone:305-743-8130
Practice Address - Fax:305-743-8140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000412600Medicaid
FL0006DOtherBCBSFL
FL8363OtherHCC LICENSE
FLCC020AMedicare PIN