Healthcare Provider Details

I. General information

NPI: 1194149013
Provider Name (Legal Business Name): NOSTALGIA ADULT DAY CARE & ACTIVITIES CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 05/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20855 N.W. 9 CT.
MIAMI GARDENS FL
33169
US

IV. Provider business mailing address

20855 N.W. 9 CT.
MIAMI GARDENS FL
33169
US

V. Phone/Fax

Practice location:
  • Phone: 305-816-6163
  • Fax: 786-916-6536
Mailing address:
  • Phone: 305-816-6163
  • Fax: 786-916-6536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9269
License Number StateFL

VIII. Authorized Official

Name: YELAMIS GONZALEZ
Title or Position: OWNER
Credential:
Phone: 305-967-9201