Healthcare Provider Details

I. General information

NPI: 1992197461
Provider Name (Legal Business Name): MOUNT OLYMPUS SENIOR CARE AND ACTIVITY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2015
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14443 COUNTRY WALK DR
MIAMI FL
33186-8103
US

IV. Provider business mailing address

14443 COUNTRY WALK DR
MIAMI FL
33186-8103
US

V. Phone/Fax

Practice location:
  • Phone: 786-230-6621
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9300
License Number StateFL

VIII. Authorized Official

Name: JENNY MOYA
Title or Position: OWNER
Credential:
Phone: 786-230-6621