Healthcare Provider Details

I. General information

NPI: 1235859919
Provider Name (Legal Business Name): HEAVENLY ADULT DAY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2022
Last Update Date: 09/01/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 SE 4TH RD
HOMESTEAD FL
33030-7301
US

IV. Provider business mailing address

20 SE 4TH RD
HOMESTEAD FL
33030-7301
US

V. Phone/Fax

Practice location:
  • Phone: 786-601-7302
  • Fax: 786-504-3349
Mailing address:
  • Phone: 786-601-7302
  • Fax: 786-504-3349

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: ARIEL MORA
Title or Position: CEO
Credential:
Phone: 786-287-2359