Healthcare Provider Details

I. General information

NPI: 1205635448
Provider Name (Legal Business Name): STEP BY STEP YOUNG ADULT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2025
Last Update Date: 08/15/2025
Certification Date: 08/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17690 NW 78TH AVE STE 104
HIALEAH FL
33015-3669
US

IV. Provider business mailing address

17601 NW 78TH AVE STE 103
HIALEAH FL
33015-3650
US

V. Phone/Fax

Practice location:
  • Phone: 786-367-1304
  • Fax: 786-542-0920
Mailing address:
  • Phone: 786-367-1304
  • Fax:

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 Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LISELY JIMENEZ
Title or Position: OWNER
Credential:
Phone: 786-367-1304