Healthcare Provider Details

I. General information

NPI: 1699417741
Provider Name (Legal Business Name): SUPREME ADULT DAY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2022
Last Update Date: 04/10/2022
Certification Date: 04/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8250 W 21ST LN STE 100
HIALEAH FL
33016-1908
US

IV. Provider business mailing address

8250 W 21ST LN STE 100
HIALEAH FL
33016-1908
US

V. Phone/Fax

Practice location:
  • Phone: 305-846-9345
  • Fax: 305-392-0316
Mailing address:
  • Phone: 305-846-9345
  • Fax: 305-392-0316

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: VIVIAN FLEITAS
Title or Position: PRESIDENT
Credential:
Phone: 305-846-9345