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General NPI Number Information
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NPI Number | 1194149013
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Entity Type | Organization
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Legal Business Name | NOSTALGIA ADULT DAY CARE & ACTIVITIES CENTER, INC.
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Dates
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Enumeration Date | 02/12/2014
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Last Update Date | 05/02/2017
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Provider Practice Location Address
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Address Line | 20855 N.W. 9 CT.
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City | MIAMI GARDENS
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State | FL
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Zip | 33169
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Country | US
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Telephone | 305-816-6163
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Fax | 786-916-6536
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Provider Business Mailing Address
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Address Line | 20855 N.W. 9 CT.
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City | MIAMI GARDENS
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State | FL
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Zip | 33169
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Country | US
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Telephone | 305-816-6163
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Fax | 786-916-6536
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Authorized Official
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Title or Position | OWNER
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Name | YELAMIS GONZALEZ
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Credential |
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Telephone | 305-967-9201
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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 | FL
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Taxonomy #2
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 9269
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License Number State | FL
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