MEDICARE: MORNING STAR ADULT DAY CARE CORP

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	311Z00000X	Custodial Care Facility	9180	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	261QA0600X	OTHER	FL	TAXONOMY

General Provider Information

NPI Number	:	1235412164
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORNING STAR ADULT DAY CARE CORP

Provider Business Mailing Address
First Line	:	2741 SW 142ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-8014
Country	:	US
Telephone Number	:	305-485-4002
Fax Number	:	305-485-4003

Provider Business Practice Location Address
First Line	:	2741 SW 142ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33175-8014
Country	:	US
Telephone Number	:	305-485-4002
Fax Number	:	305-485-4003

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARIA DEL CARMEN LOPEZ
Credential	:
Telephone Number	:	305-485-4002

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	12/10/2014

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Directions to “MORNING STAR ADULT DAY CARE CORP ” Practice Location

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