Provider Demographics
| NPI: | 1952952848 |
|---|---|
| Name: | SUNCARE MEDICAL CENTER LLC |
| Entity type: | Organization |
| Organization Name: | SUNCARE MEDICAL CENTER LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | MGR |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | YUDAISY |
| Authorized Official - Middle Name: | BARBARA |
| Authorized Official - Last Name: | HERNANDEZ |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 305-489-9090 |
| Mailing Address - Street 1: | 1782 W FLAGLER ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | MIAMI |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 33135-2017 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 305-489-9090 |
| Mailing Address - Fax: | 305-998-4963 |
| Practice Address - Street 1: | 1782 W FLAGLER ST |
| Practice Address - Street 2: | |
| Practice Address - City: | MIAMI |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 33135-2017 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 305-489-9090 |
| Practice Address - Fax: | 305-998-4963 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2019-09-23 |
| Last Update Date: | 2024-10-09 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
| No | 163W00000X | Nursing Service Providers | Registered Nurse | Group - Multi-Specialty | |
| No | 163WM1400X | Nursing Service Providers | Registered Nurse | Nurse Massage Therapist (NMT) | Group - Multi-Specialty |
| No | 1744R1102X | Other Service Providers | Specialist | Research Study | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | ||
| No | 261QA0600X | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM1300X | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | |
| No | 261QP0905X | Ambulatory Health Care Facilities | Clinic/Center | Public Health, State or Local | |
| No | 261QP1100X | Ambulatory Health Care Facilities | Clinic/Center | Podiatric | |
| No | 261QP2000X | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy | |
| No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | |
| No | 261QP3300X | Ambulatory Health Care Facilities | Clinic/Center | Pain | |
| No | 261QU0200X | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care | |
| No | 332900000X | Suppliers | Non-Pharmacy Dispensing Site |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| FL | 121452100 | Medicaid |
