Healthcare Provider Details

I. General information

NPI: 1306371414
Provider Name (Legal Business Name): CASA DEL SOL ADULT DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14770 SW 26TH STREET SUITE 102-103
MIAMI FL
33185
US

IV. Provider business mailing address

14740 SW 26TH STREET SUITE 102-103
MIAMI FL
33185
US

V. Phone/Fax

Practice location:
  • Phone: 305-310-6552
  • Fax:
Mailing address:
  • Phone: 305-456-6948
  • Fax: 305-421-0508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. RAFAEL LARA
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 786-223-2362