Healthcare Provider Details

I. General information

NPI: 1104428671
Provider Name (Legal Business Name): LIFE ADULT DAYCARE 2 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12873 SW 42ND ST
MIAMI FL
33175-3434
US

IV. Provider business mailing address

12873 SW 42ND ST
MIAMI FL
33175-3434
US

V. Phone/Fax

Practice location:
  • Phone: 305-456-0407
  • Fax: 305-456-7398
Mailing address:
  • Phone: 305-456-0407
  • Fax: 305-456-7398

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: ANA MARIA CORDERO
Title or Position: OWNER
Credential:
Phone: 786-426-0099