Provider Demographics
NPI:1336468420
Name:MIAMI LAKES CENTER FOR CARE INC
Entity Type:Organization
Organization Name:MIAMI LAKES CENTER FOR CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUVARY
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-820-5508
Mailing Address - Street 1:13903 NW 67TH AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2900
Mailing Address - Country:US
Mailing Address - Phone:305-820-5508
Mailing Address - Fax:305-820-5504
Practice Address - Street 1:13903 NW 67TH AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2900
Practice Address - Country:US
Practice Address - Phone:305-820-5508
Practice Address - Fax:305-820-5504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8038261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFILE 8217OtherAHCA HCC UNIT