Healthcare Provider Details

I. General information

NPI: 1245679588
Provider Name (Legal Business Name): LONG LIFE ADULT DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2013
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5995 SW 8TH ST
WEST MIAMI FL
33144-5037
US

IV. Provider business mailing address

5995 SW 8TH ST
WEST MIAMI FL
33144-5037
US

V. Phone/Fax

Practice location:
  • Phone: 786-384-9482
  • Fax:
Mailing address:
  • Phone: 786-384-9482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9245
License Number StateFL

VIII. Authorized Official

Name: MRS. MARJORIE RODRIGUEZ
Title or Position: OWNER
Credential:
Phone: 786-384-9482