Provider Demographics
NPI:1922443613
Name:PRO BONO CARE LLC
Entity Type:Organization
Organization Name:PRO BONO CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:YVES
Authorized Official - Middle Name:S
Authorized Official - Last Name:EVEILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-983-5330
Mailing Address - Street 1:4651 SHERIDAN ST STE 450
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3415
Mailing Address - Country:US
Mailing Address - Phone:954-983-5330
Mailing Address - Fax:954-983-5086
Practice Address - Street 1:4651 SHERIDAN ST STE 450
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3415
Practice Address - Country:US
Practice Address - Phone:954-983-5330
Practice Address - Fax:954-983-5086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53634261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0489379Medicaid
FL07625Medicare PIN
FLE21381Medicare UPIN