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General NPI Number Information
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NPI Number | 1184555641
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Entity Type | Organization
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Legal Business Name | PROVIDA ADULT DAY CARE LLC
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Dates
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Enumeration Date | 05/26/2026
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Last Update Date | 05/26/2026
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Provider Practice Location Address
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Address Line | 436 NE 125TH ST
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City | NORTH MIAMI
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State | FL
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Zip | 33161-4717
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Country | US
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Telephone | 305-602-5371
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Fax |
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Provider Business Mailing Address
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Address Line | 7900 OAK LN STE 400
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City | MIAMI LAKES
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State | FL
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Zip | 33016-6001
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Country | US
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Telephone | 305-602-5371
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIO SEPULVEDA
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Credential |
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Telephone | 305-602-5371
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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 |
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License Number State |
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