Healthcare Provider Details

I. General information

NPI: 1316669153
Provider Name (Legal Business Name): PENATE ADULT DAYCARE 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1267 W 68TH ST
HIALEAH FL
33014-4523
US

IV. Provider business mailing address

8200 SW 117TH AVE STE 112
MIAMI FL
33183-4825
US

V. Phone/Fax

Practice location:
  • Phone: 786-436-0290
  • Fax: 786-577-5253
Mailing address:
  • Phone: 305-596-7432
  • Fax: 786-433-8560

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: CLARA IDARME PENATE
Title or Position: PRESIDENT
Credential:
Phone: 786-436-0290