Healthcare Provider Details

I. General information

NPI: 1285083659
Provider Name (Legal Business Name): YOUNG AT HEART ADULT DAYCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 N UNIVERSITY DR SUITE #505
SUNRISE FL
33351-6332
US

IV. Provider business mailing address

3801 N UNIVERSITY DR SUITE #505
SUNRISE FL
33351-6332
US

V. Phone/Fax

Practice location:
  • Phone: 954-748-1151
  • Fax: 954-414-1213
Mailing address:
  • Phone: 954-748-1151
  • Fax: 954-414-1213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberME68942
License Number StateFL

VIII. Authorized Official

Name: PHILLIP CUMMINGS
Title or Position: CENTER OPERATOR
Credential: M.D.
Phone: 954-562-9527