Healthcare Provider Details

I. General information

NPI: 1700443025
Provider Name (Legal Business Name): MI CASITA SENIORS CLUB ADULT DAY CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2019
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10758 SW 24TH ST
MIAMI FL
33165-2493
US

IV. Provider business mailing address

10758 SW 24TH ST
MIAMI FL
33165-2493
US

V. Phone/Fax

Practice location:
  • Phone: 786-598-0396
  • Fax: 786-598-0399
Mailing address:
  • Phone: 786-598-0396
  • Fax: 786-598-0399

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: YIDAVEISYS SALAMANCA
Title or Position: PRESIDENT
Credential:
Phone: 786-780-6074