Healthcare Provider Details

I. General information

NPI: 1003338021
Provider Name (Legal Business Name): LIFE ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

932 SW 82ND AVE
MIAMI FL
33144-4240
US

IV. Provider business mailing address

932 SW 82ND AVE
MIAMI FL
33144-4240
US

V. Phone/Fax

Practice location:
  • Phone: 305-456-0407
  • Fax: 305-456-7397
Mailing address:
  • Phone: 305-456-0407
  • Fax: 305-456-7397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9395
License Number StateFL

VIII. Authorized Official

Name: JANINNE VALLS GONZALEZ
Title or Position: OWNER/ADMIN.
Credential:
Phone: 305-456-0407