Healthcare Provider Details

I. General information

NPI: 1881364248
Provider Name (Legal Business Name): MAGIC CITY ADULT DAYCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10740 SW 72ND ST
MIAMI FL
33173-2702
US

IV. Provider business mailing address

10740 SW 72ND ST
MIAMI FL
33173-2702
US

V. Phone/Fax

Practice location:
  • Phone: 786-312-3723
  • Fax: 305-675-2677
Mailing address:
  • Phone: 786-312-3723
  • Fax: 305-675-2677

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: ANA M PEREZ
Title or Position: OWNER
Credential:
Phone: 786-312-3723