Healthcare Provider Details

I. General information

NPI: 1508380833
Provider Name (Legal Business Name): GARDEN OF EDEN 2015 CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2017
Last Update Date: 01/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

681 E 9ST
HIALEAH FL
33010
US

IV. Provider business mailing address

681 E 9ST
HIALEAH FL
33010
US

V. Phone/Fax

Practice location:
  • Phone: 786-636-6932
  • Fax: 786-703-2137
Mailing address:
  • Phone: 786-636-6932
  • Fax: 786-703-2137

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: JUDITH ROJAS
Title or Position: PRESIDENT
Credential:
Phone: 786-636-6932