Healthcare Provider Details

I. General information

NPI: 1780972760
Provider Name (Legal Business Name): LIBERTAD ADULT DAY CARE CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 SW 122ND AVE
MIAMI FL
33184-2477
US

IV. Provider business mailing address

925 SW 122ND AVE
MIAMI FL
33184-2477
US

V. Phone/Fax

Practice location:
  • Phone: 786-536-9124
  • Fax: 786-536-9125
Mailing address:
  • Phone: 786-536-9124
  • Fax: 786-536-9125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number9170
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. YALINA CEPERO
Title or Position: MANAGER
Credential:
Phone: 305-519-6337