Healthcare Provider Details

I. General information

NPI: 1144597865
Provider Name (Legal Business Name): LOS ABUELITOS FELICES ADULT DAY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28951 S DIXIE HWY
HOMESTEAD FL
33033-2407
US

IV. Provider business mailing address

28951 S DIXIE HWY
HOMESTEAD FL
33033-2407
US

V. Phone/Fax

Practice location:
  • Phone: 305-297-4226
  • Fax:
Mailing address:
  • Phone: 305-297-4226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9171
License Number StateFL

VIII. Authorized Official

Name: MARIO CONCEPCION
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-297-4226