Provider Demographics
NPI:1649693730
Name:AGING CARE CENTER INC
Entity type:Organization
Organization Name:AGING CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-389-4214
Mailing Address - Street 1:15291 NW 60TH AVE
Mailing Address - Street 2:104
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2458
Mailing Address - Country:US
Mailing Address - Phone:305-698-8628
Mailing Address - Fax:305-698-8629
Practice Address - Street 1:15291 NW 60TH AVE
Practice Address - Street 2:104
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2458
Practice Address - Country:US
Practice Address - Phone:305-698-8628
Practice Address - Fax:305-698-8629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1212604260261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP13000101593Medicare PIN
FL=========Medicare UPIN