Healthcare Provider Details

I. General information

NPI: 1083986574
Provider Name (Legal Business Name): ST JUDE ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 04/04/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9740 S.W. 24TH STREET SECTION C
MIAMI FL
33165
US

IV. Provider business mailing address

9740 S.W. 24TH STREET SECTION C
MIAMI FL
33165
US

V. Phone/Fax

Practice location:
  • Phone: 305-221-7005
  • Fax: 888-959-1340
Mailing address:
  • Phone: 305-221-7005
  • Fax: 888-959-1340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9185
License Number StateFL

VIII. Authorized Official

Name: LILIANNY CAMEJO
Title or Position: OWNER
Credential:
Phone: 305-484-3599