Healthcare Provider Details

I. General information

NPI: 1760767941
Provider Name (Legal Business Name): GRANDPA ADULT DAY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3293 NW 7TH ST
MIAMI FL
33125-4138
US

IV. Provider business mailing address

3293 NW 7TH ST
MIAMI FL
33125-4138
US

V. Phone/Fax

Practice location:
  • Phone: 786-402-3159
  • Fax:
Mailing address:
  • Phone: 786-402-3159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9176
License Number StateFL

VIII. Authorized Official

Name: YINET ALVAREZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 786-402-3159