Healthcare Provider Details

I. General information

NPI: 1700922416
Provider Name (Legal Business Name): SAN JUDAS TADEO COMMUNITY ADULT DAY CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/13/2024
Certification Date: 08/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15628 SW 72 STREET
MIAMI FL
33193
US

IV. Provider business mailing address

15628 SW 72 STREET
MIAMI FL
33193
US

V. Phone/Fax

Practice location:
  • Phone: 305-408-0077
  • Fax: 305-408-7737
Mailing address:
  • Phone: 305-408-0077
  • Fax: 305-408-7737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9034
License Number StateFL

VIII. Authorized Official

Name: CYNTHIA DAVALOS
Title or Position: PRESIDENT
Credential:
Phone: 305-408-0077