Healthcare Provider Details

I. General information

NPI: 1134886351
Provider Name (Legal Business Name): PEACEFUL ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2021
Last Update Date: 11/22/2021
Certification Date: 11/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14900 SW 136TH ST STE 107
MIAMI FL
33196-5632
US

IV. Provider business mailing address

10311 SW 51ST ST
MIAMI FL
33165-6230
US

V. Phone/Fax

Practice location:
  • Phone: 786-709-7739
  • Fax:
Mailing address:
  • Phone: 786-709-7739
  • Fax:

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: MRS. NIURKA E MENA
Title or Position: OWNER
Credential:
Phone: 786-709-7739