MEDICARE: DBS BABY BOOMERS ADULT DAY, HEALTH & ENRICHMENT CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center	9295	FL

General Provider Information

NPI Number	:	1003212796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DBS BABY BOOMERS ADULT DAY, HEALTH & ENRICHMENT CENTER

Provider Business Mailing Address
First Line	:	14734 SW 56TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4067
Country	:	US
Telephone Number	:	786-360-1258
Fax Number	:	786-762-2182

Provider Business Practice Location Address
First Line	:	14734 SW 56TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-4067
Country	:	US
Telephone Number	:	786-360-1258
Fax Number	:	786-762-2182

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MR. JORGE LUIS GONZALEZ
Credential	:	MS
Telephone Number	:	786-360-1258

Provider Enumeration Date	:	11/07/2014
Last Update Date	:	12/03/2014

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