Healthcare Provider Details

I. General information

NPI: 1639889553
Provider Name (Legal Business Name): HAPPY PLACE ADC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2022
Last Update Date: 12/01/2022
Certification Date: 12/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 CLEVELAND AVE STE 105&107
FORT MYERS FL
33901-5850
US

IV. Provider business mailing address

2665 CLEVELAND AVE STE 105&107
FORT MYERS FL
33901-5850
US

V. Phone/Fax

Practice location:
  • Phone: 239-323-4441
  • Fax: 239-306-7534
Mailing address:
  • Phone: 239-323-4441
  • Fax: 239-306-7534

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: CAMILO RODRIGUEZ GARCIA
Title or Position: OWNER
Credential:
Phone: 786-774-6505