Healthcare Provider Details

I. General information

NPI: 1861779936
Provider Name (Legal Business Name): MIAMI SPRINGS ENTERTAINMENT & NUTRITION FOR THE ELDERLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2011
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WESTWARD DR UNIT A
MIAMI SPRINGS FL
33166-5258
US

IV. Provider business mailing address

100 WESTWARD DR UNIT A
MIAMI SPRINGS FL
33166-5258
US

V. Phone/Fax

Practice location:
  • Phone: 305-888-5003
  • Fax:
Mailing address:
  • Phone: 305-888-5003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9182
License Number StateFL

VIII. Authorized Official

Name: MS. NOLIA DIAZ
Title or Position: PRESIDENT-OWNER
Credential:
Phone: 305-888-5003