1184397606 NPI number — LARACUENTE HEALTHCARE ASSOCIATES

Table of content: (NPI 1184397606)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184397606 NPI number — LARACUENTE HEALTHCARE ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LARACUENTE HEALTHCARE ASSOCIATES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LHA CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184397606
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 E HALLANDALE BEACH BLVD STE 1004
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HALLANDALE BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33009-4636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-451-1743
Provider Business Mailing Address Fax Number:
954-838-5336

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 E HALLANDALE BEACH BLVD STE 1004
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALLANDALE BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33009-4636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-451-1743
Provider Business Practice Location Address Fax Number:
954-838-5336
Provider Enumeration Date:
07/29/2021

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LARACUENTE
Authorized Official First Name:
FERNANDO
Authorized Official Middle Name:
ALFREDO
Authorized Official Title or Position:
CLINIC DIRECTOR
Authorized Official Telephone Number:
954-451-1743

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0810X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 112571000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11094077 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 112571000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".