Provider Demographics
NPI:1356502512
Name:INCARE PHYSICIANS INCORPORATED
Entity Type:Organization
Organization Name:INCARE PHYSICIANS INCORPORATED
Other - Org Name:ARBOR HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ODALYS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARROTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-552-5222
Mailing Address - Street 1:11240 SW 30TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2206
Mailing Address - Country:US
Mailing Address - Phone:305-552-5222
Mailing Address - Fax:305-552-5222
Practice Address - Street 1:11240 SW 30TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-2206
Practice Address - Country:US
Practice Address - Phone:305-552-5222
Practice Address - Fax:305-552-5222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL10134310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1417932-00Medicaid