Healthcare Provider Details

I. General information

NPI: 1245149533
Provider Name (Legal Business Name): COCONUT CREEK ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 COCONUT CREEK PKWY STE 3D
COCONUT CREEK FL
33066-1600
US

IV. Provider business mailing address

2323 NE 26TH AVE STE 102
POMPANO BEACH FL
33062-1147
US

V. Phone/Fax

Practice location:
  • Phone: 954-933-1601
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NICHOLAS BASTO
Title or Position: OWNER
Credential:
Phone: 954-933-1691