Healthcare Provider Details

I. General information

NPI: 1003298712
Provider Name (Legal Business Name): 5 STAR ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 W 62ND ST
HIALEAH FL
33016-2657
US

IV. Provider business mailing address

2005 W 62ND ST
HIALEAH FL
33016-2657
US

V. Phone/Fax

Practice location:
  • Phone: 305-979-4888
  • Fax:
Mailing address:
  • Phone: 305-979-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. RICARDO RIVAS
Title or Position: OWNER
Credential:
Phone: 305-979-4888