Provider Demographics
NPI:1023355476
Name:FLORIDA RESPIRATORY CARE, LLC
Entity type:Organization
Organization Name:FLORIDA RESPIRATORY CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:GOURGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-326-8512
Mailing Address - Street 1:15490 SW 230TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-6900
Mailing Address - Country:US
Mailing Address - Phone:786-326-8512
Mailing Address - Fax:786-404-3481
Practice Address - Street 1:15490 SW 230TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33170-6900
Practice Address - Country:US
Practice Address - Phone:786-326-8512
Practice Address - Fax:786-404-3481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRT9098227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Single Specialty