Healthcare Provider Details

I. General information

NPI: 1013308188
Provider Name (Legal Business Name): LATIN ADULT DAY HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

663 CHARLES ST
PROVIDENCE RI
02904-1350
US

IV. Provider business mailing address

665 CHARLES ST
PROVIDENCE RI
02904
US

V. Phone/Fax

Practice location:
  • Phone: 401-709-2392
  • Fax: 401-603-0912
Mailing address:
  • Phone: 401-709-2392
  • Fax: 401-603-0912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberADC00038
License Number StateRI

VIII. Authorized Official

Name: MR. MARIO MANCEBO
Title or Position: DIRECTOR
Credential:
Phone: 401-709-2392