Healthcare Provider Details

I. General information

NPI: 1417255951
Provider Name (Legal Business Name): MILTAS PLACE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2011
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17320 NW 19TH AVE
MIAMI GARDENS FL
33056-4812
US

IV. Provider business mailing address

17320 N.W. 19TH AVE.
MIAMI GARDENS FL
33056-4812
US

V. Phone/Fax

Practice location:
  • Phone: 305-621-9143
  • Fax: 305-624-2440
Mailing address:
  • Phone: 305-621-9143
  • Fax: 305-624-2440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2055X
TaxonomyChild Mental Illness Respite Care
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateFL

VIII. Authorized Official

Name: MILDRED TASSY
Title or Position: ADMINISTRATOR
Credential:
Phone: 305-621-9143