Healthcare Provider Details

I. General information

NPI: 1336720150
Provider Name (Legal Business Name): PENATE ADULT DAYCARE 4 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4847 NW 183RD ST
MIAMI GARDENS FL
33055-2955
US

IV. Provider business mailing address

4847 NW 183RD ST
MIAMI GARDENS FL
33055-2955
US

V. Phone/Fax

Practice location:
  • Phone: 786-725-3822
  • Fax: 786-577-5253
Mailing address:
  • Phone: 786-725-3822
  • Fax: 786-577-5253

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: CLARA PENATE
Title or Position: PRESIDENT
Credential:
Phone: 786-725-3822