Healthcare Provider Details

I. General information

NPI: 1831851773
Provider Name (Legal Business Name): PURE ADULT DAYCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3152 PELL MELL DR
ORLANDO FL
32818-2829
US

IV. Provider business mailing address

3152 PELL MELL DR
ORLANDO FL
32818-2829
US

V. Phone/Fax

Practice location:
  • Phone: 407-495-9724
  • Fax:
Mailing address:
  • Phone: 407-495-9724
  • 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: YONILE DERIVOIS
Title or Position: OWNER
Credential:
Phone: 407-495-9724