Healthcare Provider Details

I. General information

NPI: 1053193268
Provider Name (Legal Business Name): JERUSALEN SENIORS ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 10/23/2023
Certification Date: 10/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13501 SW 128TH ST STE 209
MIAMI FL
33186-5863
US

IV. Provider business mailing address

13501 SW 128TH ST STE 209
MIAMI FL
33186-5863
US

V. Phone/Fax

Practice location:
  • Phone: 786-713-0868
  • Fax: 786-713-0872
Mailing address:
  • Phone: 786-713-0868
  • Fax: 786-713-0872

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: MARTA ROSA GONZALEZ
Title or Position: OWNER
Credential:
Phone: 786-713-0868