Healthcare Provider Details

I. General information

NPI: 1487925269
Provider Name (Legal Business Name): PROFESSIONAL ADULT DAY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4967 W 6TH AVE
HIALEAH FL
33012-3803
US

IV. Provider business mailing address

4967 W 6TH AVE
HIALEAH FL
33012-3803
US

V. Phone/Fax

Practice location:
  • Phone: 305-582-6690
  • Fax:
Mailing address:
  • Phone: 305-582-6690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9188
License Number StateFL

VIII. Authorized Official

Name: ANA PENA
Title or Position: OWNER
Credential:
Phone: 305-582-6690