Provider Demographics
NPI:1700550241
Name:DLC PROFESSIONAL CARE INC
Entity Type:Organization
Organization Name:DLC PROFESSIONAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FREDDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LAS CASAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-967-0128
Mailing Address - Street 1:3750 W 16TH AVE STE 132U
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4683
Mailing Address - Country:US
Mailing Address - Phone:305-967-0128
Mailing Address - Fax:
Practice Address - Street 1:3750 W 16TH AVE STE 132U
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4683
Practice Address - Country:US
Practice Address - Phone:305-967-0128
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health