Provider Demographics
NPI:1578380085
Name:MIAMI HOMECARE USA, LLC
Entity type:Organization
Organization Name:MIAMI HOMECARE USA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:YEVDAYEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:754-310-2273
Mailing Address - Street 1:4520 W HALLANDALE BEACH BLVD STE 11
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4344
Mailing Address - Country:US
Mailing Address - Phone:754-310-2237
Mailing Address - Fax:954-589-5626
Practice Address - Street 1:4520 W HALLANDALE BEACH BLVD STE 11
Practice Address - Street 2:
Practice Address - City:PEMBROKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33023-4344
Practice Address - Country:US
Practice Address - Phone:754-310-2273
Practice Address - Fax:954-589-5626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-25
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL123630100Medicaid