Provider Demographics
NPI:1790440683
Name:MEDFAMILY WELLCARE CENTER INC
Entity Type:Organization
Organization Name:MEDFAMILY WELLCARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ORESTES
Authorized Official - Middle Name:
Authorized Official - Last Name:ALFONSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-926-5023
Mailing Address - Street 1:8725 NW 18TH TER STE 312
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33172-2610
Mailing Address - Country:US
Mailing Address - Phone:786-534-3522
Mailing Address - Fax:786-590-1713
Practice Address - Street 1:8725 NW 18TH TER STE 312
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2610
Practice Address - Country:US
Practice Address - Phone:786-534-3522
Practice Address - Fax:786-590-1713
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-04
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health