Provider Demographics
NPI:1346919057
Name:PUERTO AMIGO HOME CARE LLC
Entity Type:Organization
Organization Name:PUERTO AMIGO HOME CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:GEOVANNI
Authorized Official - Last Name:BERMEO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-599-5185
Mailing Address - Street 1:3301 N COUNTRY CLUB DR APT 501
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1614
Mailing Address - Country:US
Mailing Address - Phone:954-599-5185
Mailing Address - Fax:
Practice Address - Street 1:3301 N COUNTRY CLUB DR APT 501
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1614
Practice Address - Country:US
Practice Address - Phone:954-599-5185
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care