Healthcare Provider Details

I. General information

NPI: 1639423445
Provider Name (Legal Business Name): CRYSTAL PARADISE ADULT DAY CARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 05/11/2022
Certification Date: 05/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 SW 8TH STREET-STE. 2W
MIAMI FL
33144
US

IV. Provider business mailing address

6355 SW 8TH STREET-STE. 2W
MIAMI FL
33144
US

V. Phone/Fax

Practice location:
  • Phone: 305-261-0030
  • Fax: 305-261-0032
Mailing address:
  • Phone: 305-261-0030
  • Fax: 305-261-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9219
License Number StateFL

VIII. Authorized Official

Name: KENIA PEREZ
Title or Position: OWNER
Credential:
Phone: 786-317-2890