Provider Demographics
NPI:1669157954
Name:MASTER HEALTH CARE CENTER LLC
Entity type:Organization
Organization Name:MASTER HEALTH CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ORISBEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MADRUGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-763-7202
Mailing Address - Street 1:85 GRAND CANAL DR
Mailing Address - Street 2:STE 203
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-3013
Mailing Address - Country:US
Mailing Address - Phone:786-536-7816
Mailing Address - Fax:786-536-7661
Practice Address - Street 1:85 GRAND CANAL DR
Practice Address - Street 2:STE 203
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144
Practice Address - Country:US
Practice Address - Phone:786-536-7819
Practice Address - Fax:786-536-7661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-15
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118505600Medicaid