Healthcare Provider Details

I. General information

NPI: 1164062840
Provider Name (Legal Business Name): LAS MERCEDES ADULT DAY CARE VI, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2020
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 NE 8TH ST
HOMESTEAD FL
33030-4710
US

IV. Provider business mailing address

230 NE 8TH ST
HOMESTEAD FL
33030-4710
US

V. Phone/Fax

Practice location:
  • Phone: 305-400-9985
  • Fax: 786-636-6989
Mailing address:
  • Phone: 305-400-9985
  • Fax: 786-636-6989

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: LEONOR GONZALEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-400-9985