MEDICARE: DAHLIA'S VISION SANCTUARY LLC

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	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1497697940
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAHLIA'S VISION SANCTUARY LLC

Provider Business Mailing Address
First Line	:	816 NE 149TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33161-2349
Country	:	US
Telephone Number	:	561-563-2824
Fax Number	:

Provider Business Practice Location Address
First Line	:	1408 WACKER AVE SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-5261
Country	:	US
Telephone Number	:	561-563-2824
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	DAHLIA BOYD
Credential	:
Telephone Number	:	561-563-2824

Provider Enumeration Date	:	04/06/2026
Last Update Date	:	04/06/2026

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