Healthcare Provider Details

I. General information

NPI: 1962075507
Provider Name (Legal Business Name): HAPPY HOUSE SOCIAL CLUB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5837 LAKE WORTH RD
GREENACRES FL
33463-3209
US

IV. Provider business mailing address

5837 LAKE WORTH RD
GREENACRES FL
33463-3209
US

V. Phone/Fax

Practice location:
  • Phone: 561-508-3799
  • Fax: 561-990-1347
Mailing address:
  • Phone: 561-508-3799
  • Fax: 561-990-1347

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: ALIAN MESA RIBET
Title or Position: VICE PRESIDENT
Credential:
Phone: 561-508-3799