Provider Demographics
NPI:1053729806
Name:MG CARE, LLC
Entity type:Organization
Organization Name:MG CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MAXIMILLIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:BA
Authorized Official - Phone:305-343-0673
Mailing Address - Street 1:1600 SW 145TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-7469
Mailing Address - Country:US
Mailing Address - Phone:305-343-0673
Mailing Address - Fax:813-567-2400
Practice Address - Street 1:175 FONTAINEBLEAU BLVD STE 1R10
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-4511
Practice Address - Country:US
Practice Address - Phone:305-909-9104
Practice Address - Fax:813-567-2400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-24
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010852400Medicaid