Basic Information
| Provider Information | |||||||||
| NPI: | 1336659135 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HELIX CARE MANAGEMENT | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | HELIX CARE MANAGEMENT | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7765 NW 48TH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331665404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053633675 | ||||||||
| FaxNumber: | 3054422207 | ||||||||
| Practice Location | |||||||||
| Address1: | 7765 NW 48TH ST STE 300 | ||||||||
| Address2: | |||||||||
| City: | DORAL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331665404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3053633675 | ||||||||
| FaxNumber: | 3054422207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2017 | ||||||||
| LastUpdateDate: | 06/16/2018 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | CASANOVA | ||||||||
| AuthorizedOfficialFirstName: | RENE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3053633675 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QI0500X | ME78770 | FL | N | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy | 302F00000X | ME78770 | FL | Y | Managed Care Organizations | Exclusive Provider Organization |
ID Information
| ID | Type | State | Issuer | Description | 264910101 | 05 | FL | MEDICAID |