Healthcare Provider Details

I. General information

NPI: 1124849831
Provider Name (Legal Business Name): SMILING KIDZ PPEC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4415 SHERIDAN ST
HOLLYWOOD FL
33021-3513
US

IV. Provider business mailing address

4415 SHERIDAN ST
HOLLYWOOD FL
33021-3513
US

V. Phone/Fax

Practice location:
  • Phone: 954-394-2663
  • Fax:
Mailing address:
  • Phone: 954-394-2663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM3000X
TaxonomyMedically Fragile Infants and Children Day Care
License Number
License Number State

VIII. Authorized Official

Name: YILIEN LARACUENTE
Title or Position: OWNER
Credential:
Phone: 954-394-2663