Healthcare Provider Details

I. General information

NPI: 1982126371
Provider Name (Legal Business Name): NIRVANA ADULT DAY CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 PINES BLVD, SUITE 2
PEMBROKE PINES FL
33024
US

IV. Provider business mailing address

7100 PINES BLVD STE 2
PEMBROKE PINES FL
33024-7355
US

V. Phone/Fax

Practice location:
  • Phone: 954-505-4685
  • Fax: 954-534-9506
Mailing address:
  • Phone: 954-505-4685
  • Fax: 954-534-9506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9393
License Number StateFL

VIII. Authorized Official

Name: MISS EDELMIS AMADOR
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-505-4685