Healthcare Provider Details

I. General information

NPI: 1184555641
Provider Name (Legal Business Name): PROVIDA ADULT DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 NE 125TH ST
NORTH MIAMI FL
33161-4717
US

IV. Provider business mailing address

7900 OAK LN STE 400
MIAMI LAKES FL
33016-6001
US

V. Phone/Fax

Practice location:
  • Phone: 305-602-5371
  • Fax:
Mailing address:
  • Phone: 305-602-5371
  • 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: MARIO SEPULVEDA
Title or Position: OWNER
Credential:
Phone: 305-602-5371