Provider Demographics
NPI:1447869615
Name:KINDRED SOULS PEDIATRIC CARE
Entity type:Organization
Organization Name:KINDRED SOULS PEDIATRIC CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMBR
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ABREU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-306-7608
Mailing Address - Street 1:10961 SW 186TH ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-6808
Mailing Address - Country:US
Mailing Address - Phone:305-542-4509
Mailing Address - Fax:
Practice Address - Street 1:10961 SW 186TH ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-6808
Practice Address - Country:US
Practice Address - Phone:305-542-4509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care