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General NPI Number Information
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NPI Number | 1326647363
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Entity Type | Organization
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Legal Business Name | SHINING STARS PEDIATRIC EXTENDED CARE, LLC
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Dates
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Enumeration Date | 10/21/2020
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Last Update Date | 11/08/2022
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Provider Practice Location Address
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Address Line | 5201 RAVENSWOOD RD STE 110
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City | FT LAUDERDALE
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State | FL
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Zip | 33312-6004
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Country | US
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Telephone | 786-496-0287
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Fax |
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Provider Business Mailing Address
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Address Line | 6840 SW 14TH ST
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City | MIAMI
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State | FL
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Zip | 33144-5531
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Country | US
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Telephone | 305-458-8688
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Fax |
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Authorized Official
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Title or Position | TITLE MANAGER
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Name | MRS. NATALIE MARTINEZ
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Credential |
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Telephone | 305-458-8688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM3000X
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Taxonomy Name | Medically Fragile Infants and Children Day Care
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License Number |
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License Number State |
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