MEDICARE: BLUE ANGEL ADULT DAY CARE

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	311ZA0620X	Adult Care Home Facility	9145	FL

General Provider Information

NPI Number	:	1487955225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE ANGEL ADULT DAY CARE

Provider Business Mailing Address
First Line	:	4057 SW 152ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5926
Country	:	US
Telephone Number	:	305-480-6787
Fax Number	:	305-221-6366

Provider Business Practice Location Address
First Line	:	4057 SW 152ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33185-5926
Country	:	US
Telephone Number	:	305-480-6787
Fax Number	:	305-221-6366

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MARIA C DANIEL
Credential	:	BS, RMA
Telephone Number	:	305-480-6787

Provider Enumeration Date	:	11/10/2010
Last Update Date	:	11/10/2010

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Directions to “BLUE ANGEL ADULT DAY CARE ” Practice Location

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