MEDICARE: GLADES ADULT DAYCARE & REHAB CENTER 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	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1538902457
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLADES ADULT DAYCARE & REHAB CENTER LLC

Provider Business Mailing Address
First Line	:	4021 W HAMILTON KY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-7441
Country	:	US
Telephone Number	:	561-469-7005
Fax Number	:

Provider Business Practice Location Address
First Line	:	4021 W HAMILTON KY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-7441
Country	:	US
Telephone Number	:	561-469-7005
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MARIE CARMELLE ALIZA
Credential	:
Telephone Number	:	561-707-0118

Provider Enumeration Date	:	06/18/2024
Last Update Date	:	06/18/2024

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