Healthcare Provider Details

I. General information

NPI: 1275377665
Provider Name (Legal Business Name): VIDA ADULT DAY CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2024
Last Update Date: 06/21/2024
Certification Date: 06/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26305 PARKER AVE STE 4106
HOMESTEAD FL
33032-3853
US

IV. Provider business mailing address

26305 PARKER AVE STE 4106
HOMESTEAD FL
33032-3853
US

V. Phone/Fax

Practice location:
  • Phone: 786-601-7733
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: JORGE RODRIGUEZ
Title or Position: PRESIDENT
Credential:
Phone: 305-803-8137