Healthcare Provider Details

I. General information

NPI: 1134621949
Provider Name (Legal Business Name): LLC TM'S CARE ENTERPRISE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2018
Last Update Date: 03/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9113-9117 TAFT STREET
PEMBROKE PINES FL
33024
US

IV. Provider business mailing address

9113-9117 TAFT STREET
PEMBROKE PINES FL
33024
US

V. Phone/Fax

Practice location:
  • Phone: 954-744-9389
  • Fax:
Mailing address:
  • Phone: 954-744-9389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9413
License Number StateFL

VIII. Authorized Official

Name: MRS. TAMARA PENARANDA
Title or Position: OPERATOR
Credential:
Phone: 954-744-9389