Provider Demographics
NPI:1962172395
Name:START PROFESSIONAL CARE & SUPPORT LLC
Entity type:Organization
Organization Name:START PROFESSIONAL CARE & SUPPORT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MADELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARICHAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-442-6465
Mailing Address - Street 1:3300 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-3037
Mailing Address - Country:US
Mailing Address - Phone:786-442-6465
Mailing Address - Fax:
Practice Address - Street 1:11117 W OKEECHOBEE RD STE 130
Practice Address - Street 2:
Practice Address - City:HIALEAH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33018-4210
Practice Address - Country:US
Practice Address - Phone:786-442-6465
Practice Address - Fax:305-675-2397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes253Z00000XAgenciesIn Home Supportive Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental DisabilitiesGroup - Multi-Specialty
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103102100Medicaid