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General NPI Number Information
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NPI Number | 1487955225
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Entity Type | Organization
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Legal Business Name | BLUE ANGEL ADULT DAY CARE
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Dates
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Enumeration Date | 11/10/2010
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 4057 SW 152ND AVE
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City | MIAMI
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State | FL
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Zip | 33185-5926
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Country | US
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Telephone | 305-480-6787
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Fax | 305-221-6366
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Provider Business Mailing Address
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Address Line | 4057 SW 152ND AVE
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City | MIAMI
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State | FL
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Zip | 33185-5926
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Country | US
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Telephone | 305-480-6787
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Fax | 305-221-6366
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MARIA C DANIEL
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Credential | BS, RMA
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Telephone | 305-480-6787
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | 9145
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License Number State | FL
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