Healthcare Provider Details

I. General information

NPI: 1316551062
Provider Name (Legal Business Name): MEDLEY SOCIAL CLUB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7911 NW 72ND AVE STE 108109
MEDLEY FL
33166-2227
US

IV. Provider business mailing address

7911 NW 72ND AVE STE 108109
MEDLEY FL
33166-2227
US

V. Phone/Fax

Practice location:
  • Phone: 786-781-2013
  • Fax: 305-887-1092
Mailing address:
  • Phone: 786-781-2013
  • Fax: 305-887-1092

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: MRS. DAYAMANTY PINO
Title or Position: OWNER
Credential:
Phone: 786-781-2013