Healthcare Provider Details

I. General information

NPI: 1245157940
Provider Name (Legal Business Name): PORT ORANGE ADULT DAY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 DUNLAWTON AVE STE 200-A
PORT ORANGE FL
32127-4901
US

IV. Provider business mailing address

2323 NE 26TH AVE STE 102
POMPANO BEACH FL
33062-1147
US

V. Phone/Fax

Practice location:
  • Phone: 386-878-1096
  • Fax: 386-878-1727
Mailing address:
  • Phone: 386-878-1096
  • Fax: 386-878-1727

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: NICHOLAS BASTO
Title or Position: OWNER
Credential:
Phone: 386-878-1096