Healthcare Provider Details

I. General information

NPI: 1467979435
Provider Name (Legal Business Name): JAIME'S ADULT DAY CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18950 N DALE MABRY HWY
LUTZ FL
33548-4964
US

IV. Provider business mailing address

18950 N DALE MABRY HWY
LUTZ FL
33548-4964
US

V. Phone/Fax

Practice location:
  • Phone: 813-263-6735
  • Fax: 813-961-1668
Mailing address:
  • Phone: 813-263-6735
  • Fax: 813-961-1668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9375
License Number StateFL

VIII. Authorized Official

Name: JULIE GODDARD
Title or Position: CO-OWNER
Credential:
Phone: 813-679-5984