Provider Demographics
NPI:1225066715
Name:SOUTH CARE CENTER INC
Entity Type:Organization
Organization Name:SOUTH CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:305-246-1515
Mailing Address - Street 1:15600 SW 288 STREET
Mailing Address - Street 2:SUITE #310
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1200
Mailing Address - Country:US
Mailing Address - Phone:305-246-1515
Mailing Address - Fax:305-675-0771
Practice Address - Street 1:15600 SW 288 STREET
Practice Address - Street 2:SUITE #310
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-1200
Practice Address - Country:US
Practice Address - Phone:305-246-1515
Practice Address - Fax:305-675-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK9361Medicare ID - Type Unspecified