Healthcare Provider Details

I. General information

NPI: 1003212796
Provider Name (Legal Business Name): DBS BABY BOOMERS ADULT DAY, HEALTH & ENRICHMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2014
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14734 SW 56TH ST
MIAMI FL
33185-4067
US

IV. Provider business mailing address

14734 SW 56TH ST
MIAMI FL
33185-4067
US

V. Phone/Fax

Practice location:
  • Phone: 786-360-1258
  • Fax: 786-762-2182
Mailing address:
  • Phone: 786-360-1258
  • Fax: 786-762-2182

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9295
License Number StateFL

VIII. Authorized Official

Name: MR. JORGE LUIS GONZALEZ
Title or Position: DIRECTOR
Credential: MS
Phone: 786-360-1258