MEDICARE: FANTASTIC ADULT DAYCARE 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	9590	OTHER	FL	AHCA

General Provider Information

NPI Number	:	1538922604
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FANTASTIC ADULT DAYCARE LLC

Provider Business Mailing Address
First Line	:	6878 SW 24TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-1704
Country	:	US
Telephone Number	:	305-456-0407
Fax Number	:	305-456-7398

Provider Business Practice Location Address
First Line	:	6878 SW 24TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-1704
Country	:	US
Telephone Number	:	305-456-0407
Fax Number	:	305-456-7398

Authorized Official
Title or Position	:	OWNER/ADMIN
Name	:	FELIX FERREIRO
Credential	:
Telephone Number	:	786-239-2358

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	02/01/2024

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Directions to “FANTASTIC ADULT DAYCARE LLC ” Practice Location

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