Healthcare Provider Details

I. General information

NPI: 1184013690
Provider Name (Legal Business Name): SOCIAL CENTER ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/21/2015
Last Update Date: 01/05/2024
Certification Date: 01/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104-06 WEST 76 STREET
HIALEAH FL
33018
US

IV. Provider business mailing address

3104-06 WEST 76 STREET
HIALEAH FL
33018
US

V. Phone/Fax

Practice location:
  • Phone: 305-512-3510
  • Fax: 305-512-3511
Mailing address:
  • Phone: 305-512-3510
  • Fax: 305-512-3511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License Number9305
License Number StateFL

VIII. Authorized Official

Name: MR. OSMANNY A HERRERA
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-512-3510