Healthcare Provider Details

I. General information

NPI: 1992676522
Provider Name (Legal Business Name): CLUB AMANECER ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11424 QUAIL ROOST DR
MIAMI FL
33157-6574
US

IV. Provider business mailing address

11424 QUAIL ROOST DR
MIAMI FL
33157-6574
US

V. Phone/Fax

Practice location:
  • Phone: 305-395-0281
  • Fax:
Mailing address:
  • Phone: 305-395-0281
  • Fax:

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: ALBERTO MARTINEZ MEDINA
Title or Position: OWNER
Credential:
Phone: 305-395-0281