Healthcare Provider Details

I. General information

NPI: 1699148999
Provider Name (Legal Business Name): LATIN ADULT DAY HEALTH CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 CHARLES STREET
PROVIDENCE RI
02904
US

IV. Provider business mailing address

665 CHARLES ST
PROVIDENCE RI
02904
US

V. Phone/Fax

Practice location:
  • Phone: 401-272-3252
  • Fax: 401-603-0912
Mailing address:
  • Phone: 401-272-3252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MARIO MANCEBO
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 401-272-3252