Healthcare Provider Details

I. General information

NPI: 1689042582
Provider Name (Legal Business Name): ADULT DAYCARE CENTER OF ALTAMONTE SPRINGS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 E ALTAMONTE DR
ALTAMONTE SPRINGS FL
32701-5011
US

IV. Provider business mailing address

1329 E ALTAMONTE DR
ALTAMONTE SPRINGS FL
32701-5011
US

V. Phone/Fax

Practice location:
  • Phone: 407-636-6321
  • Fax: 321-445-4740
Mailing address:
  • Phone: 407-636-6321
  • Fax: 321-445-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9323
License Number StateFL

VIII. Authorized Official

Name: MS. MARINA E NIEVES
Title or Position: ADMINISTRATOR
Credential:
Phone: 407-636-6321