Healthcare Provider Details

I. General information

NPI: 1558441329
Provider Name (Legal Business Name): ROSELAND ADULT DAYCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 SW 97TH AVE
MIAMI FL
33174-2932
US

IV. Provider business mailing address

855 SW 97TH AVE
MIAMI FL
33174-2932
US

V. Phone/Fax

Practice location:
  • Phone: 786-388-7673
  • Fax: 305-264-2771
Mailing address:
  • Phone: 786-388-7673
  • Fax: 305-264-2771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9067
License Number StateFL

VIII. Authorized Official

Name: HENRY A. RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 305-318-0121