Provider Demographics
NPI:1134452451
Name:MACEO THERAPY CENTER CORP
Entity type:Organization
Organization Name:MACEO THERAPY CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-348-8037
Mailing Address - Street 1:7171 CORAL WAY
Mailing Address - Street 2:SUITE 403
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-1449
Mailing Address - Country:US
Mailing Address - Phone:305-269-7460
Mailing Address - Fax:305-269-7462
Practice Address - Street 1:7171 CORAL WAY
Practice Address - Street 2:SUITE 403
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1449
Practice Address - Country:US
Practice Address - Phone:305-269-7460
Practice Address - Fax:305-269-7462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC7715261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center