Healthcare Provider Details

I. General information

NPI: 1639385594
Provider Name (Legal Business Name): ADAM HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 01/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 W 8TH ST
HIALEAH FL
33010-4314
US

IV. Provider business mailing address

158 W 8TH ST
HIALEAH FL
33010-4314
US

V. Phone/Fax

Practice location:
  • Phone: 305-884-1961
  • Fax:
Mailing address:
  • Phone: 305-884-1961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number5989
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number5989
License Number StateFL

VIII. Authorized Official

Name: BARBARA PEREZ
Title or Position: PRESIDENT
Credential:
Phone: 305-884-1961