Healthcare Provider Details

I. General information

NPI: 1801260443
Provider Name (Legal Business Name): CRESCENT ADULT DAY CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2015
Last Update Date: 04/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 W. 84TH ST. #65
HIALEAH FL
33014
US

IV. Provider business mailing address

1550 W. 84TH ST. #65
HIALEAH FL
33014
US

V. Phone/Fax

Practice location:
  • Phone: 305-456-2098
  • Fax: 305-456-1157
Mailing address:
  • Phone: 305-456-2098
  • Fax: 305-456-1157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9340
License Number StateFL

VIII. Authorized Official

Name: MERCEDES BARROSO
Title or Position: OWNER/ADMIN
Credential:
Phone: 786-587-2758