Healthcare Provider Details

I. General information

NPI: 1710539481
Provider Name (Legal Business Name): PARADISE SOCIAL CLUB ADULT DAY CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810-3830 E 4TH AVE
HIALEAH FL
33013
US

IV. Provider business mailing address

3810-3830 E 4TH AVE
HIALEAH FL
33013
US

V. Phone/Fax

Practice location:
  • Phone: 786-762-2686
  • Fax: 786-762-2689
Mailing address:
  • Phone: 786-762-2686
  • Fax: 786-762-2689

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: CARMEN DELAMATA
Title or Position: PRESIDENT
Credential:
Phone: 786-762-2686