Healthcare Provider Details

I. General information

NPI: 1194035980
Provider Name (Legal Business Name): XCLUSIVE SENIOR DAY CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12975 WEST OKEECHOBEE RD UNITS 3 & 4
HIALEAH GARDENS FL
33018
US

IV. Provider business mailing address

12975 WEST OKEECHOBEE RD UNITS 3 & 4
HIALEAH GARDENS FL
33018
US

V. Phone/Fax

Practice location:
  • Phone: 305-820-0805
  • Fax: 305-820-0806
Mailing address:
  • Phone: 305-820-0805
  • Fax: 305-820-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9102
License Number StateFL

VIII. Authorized Official

Name: MRS. ISABEL ACEVEDO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 305-820-0805