Healthcare Provider Details

I. General information

NPI: 1821750001
Provider Name (Legal Business Name): ABC MIAMI ADULT DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2021
Last Update Date: 10/26/2023
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11865 SW 26TH ST STE G9
MIAMI FL
33175
US

IV. Provider business mailing address

11865 SW 26TH ST STE G9
MIAMI FL
33175
US

V. Phone/Fax

Practice location:
  • Phone: 786-472-9072
  • Fax: 786-472-9071
Mailing address:
  • Phone: 786-472-9072
  • Fax: 786-472-9071

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: BORIS A GUTIERREZ JIMENEZ
Title or Position: OWNER
Credential:
Phone: 305-778-1485