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General NPI Number Information
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NPI Number | 1124473061
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Entity Type | Organization
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Legal Business Name | LITTLE HAVANA ACTIVITIES AND NUTRITION CENTERS OF DADE COUNTY
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Dates
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Enumeration Date | 04/28/2016
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Last Update Date | 06/07/2021
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Provider Practice Location Address
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Address Line | 8551 HAMMOCKS BLVD
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City | MIAMI
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State | FL
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Zip | 33193-4172
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Country | US
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Telephone | 305-858-0887
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Fax |
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Provider Business Mailing Address
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Address Line | 700 SW 8TH ST
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City | MIAMI
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State | FL
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Zip | 33130-3311
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MR. RAFAEL IGLESIAS
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Credential |
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Telephone | 305-858-0887
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 9342
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License Number State | FL
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