Healthcare Provider Details

I. General information

NPI: 1497313597
Provider Name (Legal Business Name): NEW LIFE ADULT DAY CARE CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2019
Last Update Date: 06/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22081 S DIXIE HWY
MIAMI FL
33170-2835
US

IV. Provider business mailing address

22081 S DIXIE HWY
MIAMI FL
33170-2835
US

V. Phone/Fax

Practice location:
  • Phone: 305-803-6122
  • Fax: 786-349-5747
Mailing address:
  • Phone: 305-803-6122
  • Fax: 786-349-5747

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: YAZMIN DIAZ
Title or Position: OWNER/ADMIN
Credential:
Phone: 305-803-6122