Provider Demographics
NPI:1699752501
Name:MIAMI GARDENS CARE CENTER, INC.
Entity type:Organization
Organization Name:MIAMI GARDENS CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KATZ
Authorized Official - Suffix:
Authorized Official - Credentials:NA
Authorized Official - Phone:305-651-9690
Mailing Address - Street 1:190 NE 191ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33179-3711
Mailing Address - Country:US
Mailing Address - Phone:305-651-9690
Mailing Address - Fax:305-654-9123
Practice Address - Street 1:190 NE 191ST ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33179-3711
Practice Address - Country:US
Practice Address - Phone:305-651-9690
Practice Address - Fax:305-654-9123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSNF13520963140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021061700Medicaid
FL021061700Medicaid