Provider Demographics
NPI:1588827794
Name:DADE FAMILY PROFESSIONAL SERVICES, LLC
Entity Type:Organization
Organization Name:DADE FAMILY PROFESSIONAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TATIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:BORREGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-559-6363
Mailing Address - Street 1:2711 SW 137TH AVE
Mailing Address - Street 2:SUITE #89
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6361
Mailing Address - Country:US
Mailing Address - Phone:305-555-9636
Mailing Address - Fax:305-559-6364
Practice Address - Street 1:2711 SW 137TH AVE
Practice Address - Street 2:SUITE # 89
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6361
Practice Address - Country:US
Practice Address - Phone:305-559-6363
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health