Provider Demographics
NPI:1659951135
Name:VIDACARE HEALTH CENTER LLC
Entity Type:Organization
Organization Name:VIDACARE HEALTH CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-295-8572
Mailing Address - Street 1:8501 SW 124TH AVE STE 205A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-4633
Mailing Address - Country:US
Mailing Address - Phone:786-295-8572
Mailing Address - Fax:
Practice Address - Street 1:8501 SW 124TH AVE STE 205A
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-4633
Practice Address - Country:US
Practice Address - Phone:786-295-8572
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-09
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health