Healthcare Provider Details

I. General information

NPI: 1790111326
Provider Name (Legal Business Name): GREENACRES ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2013
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6623 FOREST HILL BLVD
GREENACRES FL
33413-3303
US

IV. Provider business mailing address

6623 FOREST HILL BLVD
GREENACRES FL
33413-3303
US

V. Phone/Fax

Practice location:
  • Phone: 561-249-3856
  • Fax: 561-625-1078
Mailing address:
  • Phone: 561-249-3856
  • Fax: 561-625-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9253
License Number StateFL

VIII. Authorized Official

Name: MS. SANDHYA K MISTRY
Title or Position: ADMIN./OWNER
Credential: MT(ASCP)
Phone: 561-249-3856